AJNR. American journal of neuroradiology最新文献

{"title":"Advanced Spine Imaging: Technical Updates and Practice Recommendations.","authors":"Ajay A Madhavan, Rami W Eldaya, Lubdha M Shah, Atin Saha, Kyung K Peck, Vinil Shah, Maria Gule-Monroe, Lauren Clough Pringle, Mai-Lan Ho","doi":"10.3174/ajnr.A9314","DOIUrl":"10.3174/ajnr.A9314","url":null,"abstract":"<p><p>Advanced spine imaging has historically lagged behind brain and neck imaging for implementation into clinical practice. This is largely due to unique technical challenges including rectangular FOV, anatomic curvature, small cross section, multiple tissue interfaces, physiologic motion, and surgical hardware. For common indications such as low back pain, advanced imaging may not be necessary for routine care. However, for complex problem-solving, improved anatomic and functional spine assessment can have profound impacts on patient diagnosis, interventional planning, and outcomes. Advanced techniques can sensitively and quantitatively interrogate vertebrae, intervertebral discs, spinal canal, neural foramina, spinal cord, and nerves. This comprehensive review from the American Society of Spine Radiology Education and Standards Committee synthesizes technical principles and applications of advanced spine imaging for routine clinical use, complex problem-solving, and ongoing investigation. We present a didactic categorization of diffusion, perfusion, parametric, CSF, dynamic, anatomic, metabolic, functional, and miscellaneous techniques. Each section provides a high-level summary of technical background, key advantages and disadvantages, clinical readiness, and recommended use cases with correlative imaging examples.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147522831","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":"Predictive Accuracy and Procedural Benefits of Software-Enhanced Flow-Diverter Planning: A Systematic Review and Meta-Analysis.","authors":"Dani Douri, Paolo Panales, Bailey Riehl, Samantha Weston, Claire Westby, Sherief Ghozy, Bianca Savant, Mark Rohleder, Zachary Bueling, Abdullah Reda, Ramanathan Kadirvel, David F Kallmes","doi":"10.3174/ajnr.A9325","DOIUrl":"10.3174/ajnr.A9325","url":null,"abstract":"<p><strong>Background: </strong>Flow-diverting (FD) stents play a critical role in the management of complex intracranial aneurysms. Successful FD stent deployment requires precise planning to minimize peri- and postprocedural complications. This traditionally relied on physician expertise for precise planning; however, software simulations now offer estimative modeling.</p><p><strong>Purpose: </strong>This systematic review and meta-analysis compares physician and software simulations for predicting stent deployment and assesses the clinical impact of software integration on procedural metrics.</p><p><strong>Data sources: </strong>We searched PubMed, Embase, Web of Science, and Scopus (articles through July 18, 2025) using Nested Knowledge Autolit. The search combined Medical Subject Headings (MeSH) terms and keywords and followed updated Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A manual review of the reference lists was performed to identify gray literature.</p><p><strong>Study selection: </strong>Fourteen studies were included. All studies that involved comparative data, a physician, and software/simulation tool regarding intracranial aneurysms with outcomes relating to accuracy metrics, interobserver agreement or apposition, or procedural metrics were included.</p><p><strong>Data analysis: </strong>All data were analyzed using R, Version 4.5.2, and the \"meta\" package. Risk of bias (RoB) assessment was completed using the ROBINS-I tool for procedural metric-related studies and the COSMIN-based checklist for accuracy/agreement-related studies.</p><p><strong>Data synthesis: </strong>The pooled analysis found software-predicted stent length to be shorter than the physicians' predicted length (mean difference [MD], 2.88 mm; 95% CI, 1.25-4.51), without a statistically significant difference in diameter (MD, 0.00 mm; 95% CI, -0.09 to 0.09); software-chosen dimensions were accurate to the postimplantation length (MD, -1.40 mm; 95% CI, -3.56 to 0.76) and diameter (MD, 0.17 mm; 95% CI, -0.63 to 0.97); software-assisted cases were associated with shorter procedure duration (MD, 9.91 min; 95% CI, 1.23-18.58), lower radiation dose (MD 305.52 mGy [172.14, 438.90]), and fewer corrective interventions (OR 3.44 [1.78, 6.64]); and there was no significant difference in hemorrhagic complications (OR 1.67 [0.65, 4.28]) and postoperative aneurysm occlusion (OR 0.52 [0.07, 3.78]).</p><p><strong>Limitations: </strong>Given the retrospective nature and bias limitations of current literature, further prospective, randomized studies are warranted to better assess the clinical impact of simulation software in the endovascular treatment of intracranial aneurysms.</p><p><strong>Conclusions: </strong>The findings in this paper provide preliminary evidence to support integration of virtual simulation software in the preprocedural FD treatment planning.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147596902","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":"An Optimized MP2RAGE Protocol for Spinal Cord Imaging in Multiple Sclerosis.","authors":"Nico Papinutto, William A Stern, Simone Sacco, Ilaria Perretti, Bruce A C Cree, Stephen L Hauser, Roland G Henry","doi":"10.3174/ajnr.A9313","DOIUrl":"10.3174/ajnr.A9313","url":null,"abstract":"<p><strong>Background and purpose: </strong>MRI methods for assessing spinal cord atrophy remain underused in multiple sclerosis (MS) research and clinical practice, because even the current advanced acquisition approaches to gray matter and total cord atrophy are hampered by the presence of lesions and inefficiencies in scan time. However, improved acquisition strategies and quantitative assessment methods have the potential to provide atrophy estimates sufficiently precise to be used as outcomes in clinical trials, as well as for patient care, while simultaneously providing excellent lesion identification. We developed and optimized a novel acquisition strategy for the MP2RAGE sequence at 3T to achieve a short acquisition time protocol suitable for simultaneous estimation of gray and white matter spinal cord areas and lesion detection.</p><p><strong>Materials and methods: </strong>After MP2RAGE protocol optimization using T1 mapping in a pilot cohort of 23 MS participants with upper cord lesions, we applied the optimized protocol to a cohort of 35 MS participants with varying extent of spinal cord involvement. Two neuroradiologists independently detected lesions using the MP2RAGE uniform (UNI) image and an axial Multiple Echo Data Image Combination (MEDIC) sequence routinely used clinically. Interrater reliability of the reads was assessed, and generalized mixed models and Bowker/McNemar tests were used to compare the lesion detection efficacy of the 2 protocols. SNR and contrast-to-noise ratio (CNR) of the MP2RAGE images were computed at 3 representative cervical levels.</p><p><strong>Results: </strong>The proposed protocol provides multiple contrasts that enable clear differentiation of gray matter/white matter and cord/CSF, even in the presence of lesions, features essential for reliable atrophy measurements. The lesion detection efficacy of MP2RAGE was statistically significantly superior to the MEDIC, for both the number of detected lesioned levels and the reader's confidence. At all 3 representative levels, the CNR of the optimized protocol was comparable with what was measured for established protocols in a previous study.</p><p><strong>Conclusions: </strong>We present a 3T spinal cord optimized MP2RAGE protocol capable of covering the entire cervical spinal cord in approximately 5 minutes. This protocol offers high tissue CNR, fundamental for area quantification, as well as lesion detection efficacy comparable with that of established methods. Therefore, such a single MRI protocol could be an efficient approach for conducting clinical research.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147522821","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":"Tractography-Based Predictors of Poststroke Aphasia: A Systematic Review.","authors":"Mahshad Narimani, Iman Kiani, Hamed Ghorani, Parmida Seraj, Andrew Cho, Derek Tsang, Karthik Lalwani, Argye Hillis, Dhairya A Lakhani, Adam A Dmytriw, Ferdinand Hui, Licia Luna, Vivek Yedavalli","doi":"10.3174/ajnr.A9333","DOIUrl":"10.3174/ajnr.A9333","url":null,"abstract":"<p><strong>Background: </strong>Poststroke aphasia is a common and disabling consequence of ischemic stroke, affecting communication and quality of life. Early identification of patients at risk is essential for prognosis and rehabilitation planning. Diffusion tractography has recently been used to map white matter pathways implicated in language processing and to evaluate their predictive value for poststroke aphasia.</p><p><strong>Purpose: </strong>In this study, we aimed to evaluate the prognostic value of DTI characteristics of key white matter tracts.</p><p><strong>Data sources: </strong>A systematic search was conducted in PubMed, Embase, and Scopus until April 2025.</p><p><strong>Study selection: </strong>We considered studies eligible if they used diffusion MRI tractography to assess structural language pathways in patients with stroke and investigated their association with poststroke aphasia occurrence or severity.</p><p><strong>Data analysis: </strong>Extracted data included study characteristics, tractography methodology, language assessment tools, and key imaging findings, including tract specific diffusion metrics and tractography derived measures. Because of data insufficiency, qualitative synthesis was conducted.</p><p><strong>Data synthesis: </strong>Twenty-one studies comprising 550 patients with poststroke aphasia were included. Participants were predominantly older adults, with mean/median ages generally in the late 50s to early 70s. Baseline NIHSS values were commonly in the ∼5-14 range. The timing of diffusion/DTI acquisition varied substantially, spanning hyperacute/acute imaging, early subacute assessments, and later evaluations in the chronic phase. Studies identified left arcuate fasciculus integrity, fractional anisotropy, axial diffusivity, or reconstruction status as the strongest single predictor of aphasia severity and recovery. Loss of arcuate fasciculus reconstruction was associated with markedly lower follow-up Western Aphasia Battery Aphasia Quotient. Ventral stream involvement added prognostic value in several studies. Right hemisphere contributions were inconsistent, although higher callosal anisotropy predicted comprehension gains in 1 cohort. Overall, tract specific microstructure improved prognostic models beyond lesion volume or NIHSS, accounting for an additional 12%-29% of outcome variance in several multivariate analyses.</p><p><strong>Limitations: </strong>Methodologic variability limited cross-study comparability and precluded quantitative pooling and, as a result, generalizability.</p><p><strong>Conclusions: </strong>Tractography provides valuable insights into the structural substrates of poststroke aphasia, with the arcuate fasciculus emerging as the most robust predictor. Standardization of tractography protocols and multicenter validation are needed before routine clinical translation.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147792024","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":"Source-Separated Magnetic Susceptibility Reveals Postoperative Brain Changes in Newborns with Congenital Heart Disease.","authors":"MinJung Jang, Alexey V Dimov, Jonathan Murnick, Tarif A Choudhury, Qinghao Liang, Kushal Kapse, Anushree Kapse, Arindam RoyChoudhury, Vivien Yap, Mary T Donofrio, Ranjini Srinivasan, Gloria Chiang, Yi Wang, Catherine Limperopoulos, Zungho Zun","doi":"10.3174/ajnr.A9344","DOIUrl":"10.3174/ajnr.A9344","url":null,"abstract":"<p><strong>Background and purpose: </strong>Congenital heart disease (CHD) is a leading risk factor for neurodevelopmental impairments, yet the underlying brain alterations in the early postnatal period remain poorly understood. This prospective study measured regional magnetic susceptibilities to characterize tissue composition changes in the brain of newborns with CHD.</p><p><strong>Materials and methods: </strong>A total of 51 newborns with CHD requiring cardiac surgery and 69 healthy controls were enrolled. Of these, 42 newborns with CHD and 65 healthy controls were included in the analysis, resulting in 29 preoperative MRI scans (postmenstrual age [PMA] = 39.1 ± 1.2 weeks), 28 postoperative MRI scans (PMA = 43.0 ± 2.1 weeks), and 65 control scans (PMA = 42.8 ± 2.3 weeks). Quantitative susceptibility mapping (QSM) with source separation was performed to assess paramagnetic susceptibility and diamagnetic susceptibility. In a subset of the cohort, postoperative C-reactive protein (CRP) levels were measured to assess systemic inflammation and the Bayley Scales of Infant and Toddler Development, Third Edition (Bayley-III) test was performed at 18 months to evaluate neurodevelopment.</p><p><strong>Results: </strong>Postoperative CHD scans demonstrated higher paramagnetic susceptibility in the thalamus and frontal lobe and higher diamagnetic susceptibility in the deep gray matter, lentiform nucleus, thalamus, and occipital lobe, compared with controls (all <i>P</i> < .05), whereas no differences were observed between preoperative CHD and control scans. Within the CHD group, single-ventricle physiology was associated with higher postoperative paramagnetic susceptibility and diamagnetic susceptibility compared with 2-ventricle physiology (<i>P</i> < .05). In addition, postoperative paramagnetic susceptibility and diamagnetic susceptibility showed positive associations with postoperative CRP levels and negative associations with Bayley-III developmental scores at 18 months of age, particularly in receptive language and gross motor domains (<i>P</i> < .05).</p><p><strong>Conclusions: </strong>These findings suggest that susceptibility alterations emerge after cardiac surgery and are linked to poorer developmental outcomes. Source-separated QSM may serve as a sensitive biomarker of brain tissue alterations and neurodevelopmental risk in newborns with CHD.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147679283","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":"Portable MRI in Pediatrics: Weighing the Costs and Benefits. Revolution or Novelty?","authors":"Taylor A Hill-Horowitz, Benjamin Bases, Jiashu Wang, Genesis Liriano, Sweety John, Andrew Kobets","doi":"10.3174/ajnr.A9305","DOIUrl":"10.3174/ajnr.A9305","url":null,"abstract":"<p><p>Portable MRI (pMRI) addresses several limitations of conventional MRI (cMRI): it can be operated at the bedside and is less expensive. However, its lower magnetic field strength produces lower-quality images, limiting the reliable detection of subtle brain injury. This review examines pMRI utility within a pediatric hospital. Current evidence suggests that pMRI offers advantages for hospital care. Bedside imaging eliminates the need to transport critically ill patients to MRI suites, expanding access for children who cannot undergo cMRI. pMRI also reduces equipment costs and energy use per scan. pMRI performs well in identifying large intracranial processes (hydrocephalus, cerebral edema, intraparenchymal hemorrhage, and midline shift). However, it is less reliable for detecting small parenchymal injuries, subtle white-matter changes, infarcts, and small-volume hemorrhages. Motion artifact is a key limitation in pediatrics, where patient stillness is difficult. Because an advantage of MRI over CT is detecting small-scale pathology, defining the clinical role of pMRI is important. Overall, pMRI is a valuable complement to cMRI and CT in hospitals with bedside monitoring needs, critical care imaging demands, or limited MRI access. However, due to lower spatial resolution and SNR, pMRI cannot yet replace cMRI for evaluating subtle pediatric brain injuries.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147517474","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":"Neuro Optical Coherence Tomography Imaging for Intracranial Aneurysm Treatment: A Technical Video Case.","authors":"Géraud Forestier, Nicole M Cancelliere, Pedro Lylyk, Giovanni J Ughi, Vitor M Pereira","doi":"10.3174/ajnr.A9561","DOIUrl":"10.3174/ajnr.A9561","url":null,"abstract":"<p><p>Endovascular therapies are increasingly becoming the primary approach for treating cerebrovascular disorders.^1,2 However, these procedures rely on DSA, which provides limited visualization due to inherently limited spatial resolution.³ Intravascular optical coherence tomography (OCT) enables 3D, high-resolution visualization of the coronary arteries, allowing detailed assessment of the vascular wall, atherosclerotic plaque characteristics, and stent deployment.⁴ OCT has led cardiology societies to recommend intravascular imaging for the management of complex coronary interventions (level 1A evidence).^5,6 OCT is now being adapted for neurointerventional applications.⁷ A dedicated neuro-OCT (<i>n</i>OC; Spryte Medical) technology, designed to enable OCT imaging in tortuous intracranial arteries, has been recently introduced.⁸ Initial studies showed <i>n</i>OCT safety and feasibility for neurovascular use and explored its potential value for improved intracranial vascular imaging in stroke settings.⁹ The successful integration of <i>n</i>OCT technology into clinical workflows requires standardized principles for image acquisition and interpretation.^10,11 This video describes how to use <i>n</i>OCT in clinical practice.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148633135","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":"Sub-Torcular Cranial Venous Outflow in Intracranial Venous Hypertension: Anatomic and Hemodynamic Insights Following Venous Sinus Stenting.","authors":"Christopher H Sollenberger, Aaron Anandarajah, Aanand Mehta, Zachary Hoglund, Albert Q Wu, Kyle Scott, Joshua S Catapano, Jan Karl Burkhardt, Sandeep Kandregula, Redi Rahmani, Visish M Srinivasan","doi":"10.3174/ajnr.A9656","DOIUrl":"https://doi.org/10.3174/ajnr.A9656","url":null,"abstract":"<p><strong>Background and purpose: </strong>Venous sinus stenosis is a recognized cause of venopathic intracranial hypertension (VIH) and a therapeutic target in idiopathic intracranial hypertension (IIH). Previously observed sub-torcular venous collateral flow is poorly classified, and their dynamics following venous sinus stenting (VSS) remain poorly understood. This study aimed to better describe these venous collaterals in patients undergoing VSS.</p><p><strong>Materials and methods: </strong>We retrospectively reviewed consecutive adults who underwent VSS for venous sinus stenosis with high-resolution 2D venography between January 2024 and June 2025. Three neurointerventional reviewers independently classified collaterals by anatomical origin: Type 1 (torcula/transverse origin), Type 2 (sigmoid sinus origin), or Type 3 (jugular bulb origin). Pre- and immediate post-stent venograms were qualitatively assessed for collateral flow resolution and quantitatively analyzed to calculate percent change in collateral areas and Jaccard similarity indices following spatial alignment.</p><p><strong>Results: </strong>The cohort comprised 41 unique patients who underwent 48 VSS procedures (92% female; mean age 38.5 ± 12.2 years). Among the 48 procedures, sub-torcular collaterals were present in 46 (96%): Type 1 in 21 (44%), Type 2 in 14 (29%), and Type 3 in 30 (63%); 17 procedures (35%) had multiple types. Expert interobserver agreement was almost perfect for Type 1 and substantial for Types 2 and 3 (Fleiss κ=0.856, 0.745, and 0.687, respectively). Qualitative post-stenting collateral status differed between Types 1 and 3 (p=0.02). Type 3 channels remained angiographically opacified in 16/30 procedures, whereas Type 1 flow more often decreased (11/21) or was no longer opacified (7/21). Quantitatively (n=29), neither median percent change in area (Type 1: 13.22% vs Type 3: 16.32%, p=0.76) nor Jaccard index (Type 1: 57.56 vs Type 3: 63.67, p=0.24) differed significantly.</p><p><strong>Conclusions: </strong>Sub-torcular venous collaterals are common in patients with VIH undergoing VSS and can be classified by anatomical origin. Jugular bulb-origin collateral flow decreased less often post-stenting than torcular-origin collaterals, a difference more apparent on qualitative assessment than on current quantitative metrics. These findings suggest that subtorcular venous collateral assessment can be standardized despite clinical variability and that such pathways represent a component of cerebral venous adaptation in the setting of venous sinus stenosis.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149129380","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":"Predictors of early unfavorable outcomes in low NIHSS stroke patients undergoing thrombectomy: A case-control analysis of the Canadian OPTIMISE registry.","authors":"Timothé Langlois-Thérien, Alexandre Y Poppe, Samuel Yip, Steve Verreault, Darren Ferguson, Amy Y X Yu, Jennifer Mandzia, George Medvedev, Aristeidis H Katsanos, Grant Stotts, Grégory Jacquin","doi":"10.3174/ajnr.A9654","DOIUrl":"https://doi.org/10.3174/ajnr.A9654","url":null,"abstract":"<p><strong>Background: </strong>The benefit of endovascular thrombectomy (EVT) for patients with large vessel occlusion (LVO) stroke and National Institutes of Health Stroke Scale (NIHSS) ≤5 remains uncertain. Despite their initially mild presentations, many experience early deterioration and poor long-term outcomes. However, EVT carries procedural risks. We aimed to determine the prevalence of early unfavorable outcomes in EVT-treated low NIHSS patients and identify modifiable predictors.</p><p><strong>Material and methods: </strong>We conducted a retrospective case-control study using the Canadian OPTIMISE registry which captured EVT data nationwide (2018-2021). Adult patients with LVO stroke and admission NIHSS ≤5 treated with EVT were included. The primary endpoint, \"early unfavorable outcome,\" was a composite of early neurological deterioration (NIHSS increase ≥4 within 24 h), symptomatic intracranial hemorrhage, in-hospital death, or discharge to long-term care. Cases were all patients meeting this endpoint; controls were matched 4:1 by age, sex, and baseline NIHSS. Modifiable predictors were analyzed using multivariable conditional logistic regression.</p><p><strong>Results: </strong>Among 439 EVT-treated low NIHSS stroke patients, 50 (11%) experienced early unfavorable outcomes and were matched to 200 controls without unfavorable outcome. Unsuccessful reperfusion (TICI <2b) was the only modifiable factor significantly associated with early unfavorable outcomes (aOR 41.52, 95% CI 5.31-324.62, p<0.001). Prior IV thrombolysis, thrombectomy technique, and procedural complications were not associated.</p><p><strong>Conclusions: </strong>About one in ten EVT-treated low NIHSS patients experienced early unfavorable outcomes. Unsuccessful reperfusion was the strongest determinant. While reperfusion success is multifactorial and not entirely modifiable, this finding suggests that additional efforts to achieve complete recanalization in selected patients can be considered in appropriately selected patients. These findings provide real-world multicenter evidence pending the completion of ongoing randomized trials evaluating EVT in low NIHSS stroke.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149129287","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 Dynamic Vasoactive Response of Cerebral White Matter Under Hemodynamic Provocation.","authors":"Yihui Zhu, James Michael Gee, Xiuyuan Wang, Siddhant Dogra, Jelle Veraart, Koto Ishida, Seena Dehkharghani","doi":"10.3174/ajnr.A9669","DOIUrl":"https://doi.org/10.3174/ajnr.A9669","url":null,"abstract":"<p><strong>Background and purpose: </strong>The dynamics of white matter cerebrovascular reactivity (CVR) are affected by macrovascular steno-occlusive disease (SOD), but may further vary between normal-appearing white matter (NAWM) and microangiopathic white matter hyperintensities (WMH). Here, we assess the temporal dynamics of the white matter vasoactive response, including interactions between WMH and SOD using a dedicated computational pipeline to isolate transient maximal (<i>CVR_max</i> ) and terminal (<i>CVR_end</i> ) CVR and newly isolated <i>time-to-maximum</i> (<i>CVR_Tmax</i> ) of the pharmacologic response to acetazolamide-augmented dynamic BOLD (ACZ-BOLD) hypothesizing differential temporal responses and hemodynamic phenotypes.</p><p><strong>Materials and methods: </strong>Nineteen adults with angiographically-confirmed unilateral, chronic intracranial SOD underwent a total of 25 twenty-minute ACZ-BOLD examinations. Normal-appearing (NAWM) and microangiopathic (WMH) white matter voxels were manually segmented and classified into four tissue groups based on laterality to SOD, i.e.: <i>NAWM_contra</i> , <i>WMH_contra</i> , <i>NAWM_ipsi</i> , and <i>WMH_ipsi</i> . Median <i>CVR_max</i> and <i>CVR_end</i> were analyzed using linear mixed-effects models. The <i>time-to-maximum</i> of the CVR (<i>CVR_Tmax</i> ) and the terminal-to-maximum CVR ratio (<i>CVR_end</i> /<i>CVR_max</i> ) were additionally constructed and compared.</p><p><strong>Results: </strong>Among the full cohort, ipsilateral WMH demonstrated the lowest estimated <i>CVR_max</i> . The laterality effect was in the hypothesized direction but did not reach statistical significance (β=-0.211; 95% CI:[-0.445, 0.023]; P=0.08). The tissue-by-laterality interaction also suggested an additional reduction in ipsilateral WMH but did not reach statistically significant differences (β=-0.293; 95% CI:[-0.624, 0.038]; P=0.08). Eight examinations from 8 different subjects exhibited paradoxical reverse-steal profiles, and upon their exclusion differences were amplified including significantly lower <i>CVR_max</i> ipsilateral to SOD (β=-0.579; 95% CI:[-0.794, -0.36]; P<0.001). Reverse-steal examinations demonstrated notably altered dynamics with delayed ipsilateral <i>CVR_Tmax</i> (P=0.004) and higher <i>CVR_end</i> /<i>CVR_max</i> ratios (P=0.03).</p><p><strong>Conclusions: </strong>The dynamics of the CVR response can reveal differential and previously occult temporal signatures in the pharmacologic response of white matter to ACZ, suggesting potential interactions between macrovascular and microvascular hemodynamic impairment.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149120099","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}