AJNR. American journal of neuroradiology最新文献

{"title":"Advancing Neuroradiology through Innovation and Member Engagement.","authors":"","doi":"10.3174/ajnr.A8708","DOIUrl":"https://doi.org/10.3174/ajnr.A8708","url":null,"abstract":"","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":"46 4","pages":"645"},"PeriodicalIF":0.0,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143775102","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":"Thrombectomy Alone or Alongside Intravenous Thrombolysis in Managing Acute Ischemic Stroke Caused by Basilar Artery Occlusion: A Multicenter Observational Study.","authors":"Mo Yang, Yue-Zhou Cao, Peng-Hua Lv, Yasuo Ding, Zhensheng Liu, Zhenyu Jia, Lin-Bo Zhao, Chuan Xu, Hai-Bin Shi, Sheng Liu","doi":"10.3174/ajnr.A8520","DOIUrl":"10.3174/ajnr.A8520","url":null,"abstract":"<p><strong>Background and purpose: </strong>It remains unclear whether the combination of endovascular treatment (EVT) with intravenous thrombolysis (IVT) results in a more favorable functional outcome than EVT alone in managing cases of acute ischemic stroke (AIS) caused by basilar artery occlusion (BAO). Thus, this study aimed to compare the outcomes of 2 approaches-direct endovascular treatment (DEVT) and bridging therapy (IVT plus EVT)-in patients with acute BAO presenting within 4.5 hours of stroke onset.</p><p><strong>Materials and methods: </strong>This multicenter retrospective cohort study included 153 patients with acute BAO presenting within 4.5 hours of stroke onset. Of these patients, 65 (42.5%) and 88 (57.5%) underwent DEVT and bridging therapy, respectively. The primary outcome was defined as good functional outcome (mRS, 0-3) at 90 days. Additionally, preoperative clinical features, thrombectomy attempts, successful reperfusion rates, incidences of symptomatic intracranial hemorrhage (sICH), and mortality were compared between the 2 groups.</p><p><strong>Results: </strong>At 90 days, the rate of good functional outcome was comparable between the DEVT (44.6%) and bridging-therapy (39.8%) groups (adjusted odds ratio [aOR], 1.12; 95% CI, 0.55-2.31; <i>P</i> = .753). The bridging-therapy group exhibited a lower percentage of patients requiring ≥3 attempts of stent retrieval (aOR, 0.39; 95% CI, 0.16-0.93; <i>P</i> = .034). Preoperative clinical features, rate of successful reperfusion, sICH, and mortality were similar between the 2 groups.</p><p><strong>Conclusions: </strong>In patients with BAO-induced AIS, DEVT demonstrates a comparable functional outcome to bridging therapy within 4.5 hours of symptom onset, but IVT reduces the number of thrombectomy attempts.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":"706-711"},"PeriodicalIF":0.0,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142334167","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":"Embolization of Posterior Fossa Meningiomas Supplied with Meningohypophyseal Trunk by Using <i>n</i>-BCA and Dual Balloon Protection.","authors":"Jota Tega, Koichiro Takemoto, Takayuki Koga, Dai Kawano, Shintaro Yoshinaga, Hideaki Tanaka, Kei Yamashiro, Toshiyuki Enomoto, Hironori Fukumoto, Yoshinobu Horio, Hiromasa Kobayashi, Takashi Morishita, Mitsutoshi Iwaasa, Hiroshi Abe","doi":"10.3174/ajnr.A8536","DOIUrl":"10.3174/ajnr.A8536","url":null,"abstract":"<p><strong>Background and purpose: </strong>Efficacy of tumor embolization for posterior fossa meningioma is controversial due to the lack of adequate embolization for dangerous feeders. Of these, a meningohypophyseal trunk (MHT) has high therapeutic value despite the high risks associated with embolization.</p><p><strong>Materials and methods: </strong>To analyze the utility of preoperative MHT embolization for posterior fossa meningiomas by using <i>n-</i>BCA with dual balloon protection, a single-center retrospective record review was performed on 8 consecutive patients who underwent preoperative tumor embolization via the MHT for posterior fossa meningiomas between 2020 and 2024.</p><p><strong>Results: </strong>In all cases the MHT was successfully embolized by using <i>n-</i>BCA. Complete obliteration was achieved in 5 cases, which is related to the tentorial artery alone as the feeding vessel. None of the patients had cerebral infarction associated with distal embolization. One patient experienced worsening of preoperatively observed abducens nerve palsy due to cranial nerve ischemia. Gross total resection was achieved in 7 of 8 cases. The mean estimated blood loss during surgical resection was 186 mL (range, 39-392 mL). The mean operative time was 431 minutes (range, 317-767 minutes).</p><p><strong>Conclusions: </strong>The MHT embolization of posterior fossa meningiomas by using <i>n</i>-BCA is technically feasible with a high success rate and an acceptable complication rate.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":"720-724"},"PeriodicalIF":0.0,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142482792","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":"Morphometric Evaluation of the Facial and Vestibulocochlear Nerves Using MR Imaging in Patients with Menière Disease.","authors":"Wilhelm H Flatz, Annika Henneberger-Kunz, Regina Schinner, Ullrich Müller-Lisse, Maximilian Reiser, Birgit Ertl-Wagner","doi":"10.3174/ajnr.A8537","DOIUrl":"10.3174/ajnr.A8537","url":null,"abstract":"<p><strong>Background and purpose: </strong>Menière disease (MD) is a condition of unknown etiology, involving genetic predisposition, autoimmune processes, viral infections, cellular apoptosis, and oxidative stress. This study aimed to investigate potential differences in cranial nerves VII and VIII in patients with MD using hydrops MRI (FLAIR) for morphometric evaluations.</p><p><strong>Materials and methods: </strong>Sequences acquired were 3T MRI, CISS, and 3D FLAIR. We evaluated the morphometrics of cranial nerves VII and VIII from the cerebellopontine angle to the internal auditory canal fundus, comparing the nonaffected and affected sides. Furthermore, we examined the findings in relation to symptom duration and evaluated the feasibility of FLAIR in the morphometry of the cranial nerves.</p><p><strong>Results: </strong>A total of 53 patients with MD with unilateral symptoms were included. After statistical analysis, no significant differences were found regarding morphometric changes in the affected side compared with the nonaffected side of cranial nerves VII and VIII. There was also no significant difference between the morphometric evaluations of patients with different symptom durations. The morphometric evaluation using hydrops MRI sequences (FLAIR) showed no significant difference compared with established morphometric highly T2-weighted imaging (CISS).</p><p><strong>Conclusions: </strong>Our data found no differences in nerve morphometry between clinically nonaffected and affected sides in patients with unilateral MD, nor any correlation with symptom duration. This finding contrasts with previous ones of correlations between clinical features and endolymphatic hydrops. A disease process starting before clinical symptom onset could be a possible explanation. Morphometric evaluation of brain nerves using hydrops MRI sequences is practical and provides similar results compared with T2-weighted imaging, improving patient comfort and reducing MRI scan times.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":"792-799"},"PeriodicalIF":0.0,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142482793","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-Based Reconstruction for Accelerated Cervical Spine MRI: Utility in the Evaluation of Myelopathy and Degenerative Diseases.","authors":"So Jung Koo, Roh-Eul Yoo, Kyu Sung Choi, Kyung Hoon Lee, Han Byeol Lee, Dong-Joo Shin, Hyunsuk Yoo, Seung Hong Choi","doi":"10.3174/ajnr.A8567","DOIUrl":"10.3174/ajnr.A8567","url":null,"abstract":"<p><strong>Background and purpose: </strong>Deep learning (DL)-based reconstruction enables improving the quality of MR images acquired with a short scan time. We aimed to prospectively compare the image quality and diagnostic performance in evaluating cervical degenerative spine diseases and myelopathy between conventional cervical MRI and accelerated cervical MRI with a commercially available vendor-neutral DL-based reconstruction.</p><p><strong>Materials and methods: </strong>Fifty patients with degenerative cervical spine disease or myelopathy underwent both conventional cervical MRI and accelerated cervical MRI by using a DL-based reconstruction operating within the DICOM domain. The images were evaluated both quantitatively, based on SNR and contrast-to-noise ratio (CNR), and qualitatively, by using a 5-point scoring system for the overall image quality and clarity of anatomic structures on sagittal T1WI, sagittal contrast-enhanced (CE) T1WI, and axial/sagittal T2WI. Four radiologists assessed the sensitivity and specificity of the 2 protocols for detecting degenerative diseases and myelopathy.</p><p><strong>Results: </strong>The DL-based protocol reduced MRI acquisition time by 47%-48% compared with the conventional protocol. DL-reconstructed images demonstrated a higher SNR on sagittal T1WI (<i>P</i> = .046) and a higher CNR on sagittal T2WI (<i>P</i> = .03) than conventional images. The SNR on sagittal T2WI and the CNR on sagittal T1WI did not significantly differ (<i>P</i> > .05). DL-reconstructed images had better overall image quality on sagittal T1WI (<i>P</i> < .001), sagittal T2WI (Dixon in-phase or TSE) (<i>P</i> < .001), and sagittal T2WI (Dixon water-only) (<i>P</i> = .013) and similar image quality on axial T2WI and sagittal CE T1WI (<i>P</i> > .05). DL-reconstructed images had better clarity of anatomic structures (<i>P</i> values were < .001 for all structures, except for the neural foramen [<i>P</i> = .024]). DL-reconstructed images had a higher sensitivity for detecting neural foraminal stenosis (<i>P</i> = .005) and similar sensitivities for diagnosing other degenerative spinal diseases and myelopathy (<i>P</i> > .05). The specificities for diagnosing degenerative spinal diseases and myelopathy did not differ between the 2 images (<i>P</i> > .05).</p><p><strong>Conclusions: </strong>The accelerated cervical MRI reconstructed with a vendor-neutral DL-based reconstruction algorithm did not compromise image quality and had higher or similar diagnostic performance for diagnosing cervical degenerative spine diseases and myelopathy compared with the conventional protocol.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":"750-757"},"PeriodicalIF":0.0,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143733546","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":"Comprehensive Segmentation of Gray Matter Structures on T1-Weighted Brain MRI: A Comparative Study of Convolutional Neural Network, Convolutional Neural Network Hybrid-Transformer or -Mamba Architectures.","authors":"Yujia Wei, Jaidip Manikrao Jagtap, Yashbir Singh, Bardia Khosravi, Jason Cai, Jeffrey L Gunter, Bradley J Erickson","doi":"10.3174/ajnr.A8544","DOIUrl":"10.3174/ajnr.A8544","url":null,"abstract":"<p><strong>Background and purpose: </strong>Recent advances in deep learning have shown promising results in medical image analysis and segmentation. However, most brain MRI segmentation models are limited by the size of their data sets and/or the number of structures they can identify. This study evaluates the performance of 6 advanced deep learning models in segmenting 122 brain structures from T1-weighted MRI scans, aiming to identify the most effective model for clinical and research applications.</p><p><strong>Materials and methods: </strong>A total of 1510 T1-weighted MRIs were used to compare 6 deep learning models for the segmentation of 122 distinct gray matter structures: nnU-Net, SegResNet, SwinUNETR, UNETR, U-Mamba_BOT, and U-Mamba_ Enc. Each model was rigorously tested for accuracy by using the dice similarity coefficient (DSC) and the 95th percentile Hausdorff distance (HD95). Additionally, the volume of each structure was calculated and compared between normal controls (NCs) and patients with Alzheimer disease (AD).</p><p><strong>Results: </strong>U-Mamba_Bot achieved the highest performance with a median DSC of 0.9112 (interquartile range [IQR]: 0.8957, 0.9250). nnU-Net achieved a median DSC of 0.9027 [IQR: 0.8847, 0.9205], and had the highest HD95 of 1.392 [IQR: 1.174, 2.029]. The value of each HD95 (<3 mm) indicates its superior capability in capturing detailed brain structures accurately. Following segmentation, volume calculations were performed, and the resultant volumes of NCs and patients with AD were compared. The volume changes observed in 13 brain substructures were all consistent with those reported in existing literature, reinforcing the reliability of the segmentation outputs.</p><p><strong>Conclusions: </strong>This study underscores the efficacy of U-Mamba_Bot as a robust tool for detailed brain structure segmentation in T1-weighted MRI scans. The congruence of our volumetric analysis with the literature further validates the potential of advanced deep learning models to enhance the understanding of neurodegenerative diseases such as AD. Future research should consider larger data sets to validate these findings further and explore the applicability of these models in other neurologic conditions.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":"742-749"},"PeriodicalIF":0.0,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142482791","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":"Automated Quantification of Cerebral Microbleeds in SWI: Association with Vascular Risk Factors, White Matter Hyperintensity Burden, and Cognitive Function.","authors":"Ji Su Ko, Yangsean Choi, Eun Seon Jeong, Hyun-Jung Kim, Grace Yoojin Lee, Ji Eun Park, Namkug Kim, Ho Sung Kim","doi":"10.3174/ajnr.A8552","DOIUrl":"10.3174/ajnr.A8552","url":null,"abstract":"<p><strong>Background and purpose: </strong>The amount and distribution of cerebral microbleeds (CMB) are important risk factors for cognitive impairment. Our objective was to train and validate a deep learning (DL)-based segmentation model for cerebral microbleeds (CMBs) on SWI and to find associations among CMB, cognitive impairment, and vascular risk factors.</p><p><strong>Materials and methods: </strong>Participants in this single-institution retrospective study underwent brain MRI to evaluate cognitive impairment between January and September 2023. For training the DL model, the nnU-Net framework was used without modifications. The performance of the DL model was evaluated on independent internal and external validation data sets. Linear regression analysis was used to find associations among log-transformed CMB numbers, cognitive function (Mini-Mental Status Examination [MMSE]), white matter hyperintensity (WMH) burden, and clinical vascular risk factors (age, sex, hypertension, diabetes, lipid profiles, and body mass index).</p><p><strong>Results: </strong>Training of the DL model (<i>n</i> = 287) resulted in a robust segmentation performance with an average Dice score of 0.73 (95% CI, 0.67-0.79) in an internal validation set (<i>n</i> = 67) and modest performance in an external validation set (Dice score = 0.46; 95% CI, 0.33-0.59; <i>n</i> = 68). In a temporally independent clinical data set (<i>n</i> = 448), older age, hypertension, and WMH burden were significantly associated with CMB numbers in all distributions (total, lobar, deep, and cerebellar; all <i>P </i>< .<i> </i>01). The MMSE was significantly associated with hyperlipidemia (β = 1.88; 95% CI, 0.96-2.81; <i>P </i>< .<i> </i>001), WMH burden (β = -0.17 per 1% WMH burden, 95% CI, -0.27-0.08; <i>P</i> < . 001), and total CMB number (β = -0.01 per 1 CMB, 95% CI, -0.02-0.001; <i>P</i> = .04) after adjusting for age and sex.</p><p><strong>Conclusions: </strong>The DL model showed a robust segmentation performance for CMB. In all distributions, CMB had significant positive associations with WMH burden. Increased WMH burden and CMB numbers were associated with decreased cognitive function.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142514456","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":"Revisiting a Rare Anomaly Described 25 Years Ago in the AJNR: A Journey from Pediatric Hemifacial Microsomia and Middle Cranial Fossa Aplasia to CSF-Lymphatic Fistula and Spontaneous Intracranial Hypotension as an Adult.","authors":"Andrew L Callen, Ashoke R Khanwalkar, Michael L Cunningham, Samantha L Pisani Petrucci, Debayan Bhaumik, Danielle Wilhour, Premal Trivedi, Peter Lennarson, David A Zander","doi":"10.3174/ajnr.A8760","DOIUrl":"https://doi.org/10.3174/ajnr.A8760","url":null,"abstract":"<p><p>This report presents a unique case of a 39-year-old female with a congenital unilateral aplasia of the middle cranial fossa floor associated with atypical hemifacial microsomia, initially described in a case report at age 14, who later developed a transosseous cerebrospinal fluid (CSF)-lymphatic fistula through the C1 vertebral body. Dynamic CT cisternography confirmed the diagnosis, and a transnasal percutaneous fibrin glue occlusion successfully reversed the patient's brain sag and improved her symptoms. This case highlights the evolving understanding of CSF dynamics and the diagnostic and therapeutic challenges posed by rare CSF leak variants.ABBREVIATIONS: CSF = cerebrospinal fluid; SIH = spontaneous intracranial hypotension.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143733551","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":"Long-term (12 months) Outcomes of Endovascular Thrombectomy for Large Stroke: A Meta-Analysis of SELECT2, TESLA, TENSION, and LASTE trials.","authors":"Ali Mortezaei, Muhammed Amir Essibayi, Ahmed Abdelsalam, Joshua Hanna, Redi Rahmani, David J Altschul, Robert M Starke","doi":"10.3174/ajnr.A8749","DOIUrl":"https://doi.org/10.3174/ajnr.A8749","url":null,"abstract":"<p><strong>Background: </strong>Endovascular thrombectomy (EVT) has demonstrated benefits over standard medical care (MC) in randomized controlled trials (RCTs) for patients with large vessel occlusion (LVO) and large infarct territory at 90 days. However, conflicting evidence exists regarding long-term safety and efficacy of EVT in these populations.</p><p><strong>Purpose: </strong>To evaluate the clinical benefits of EVT in patients with large-core infarction through meta-analysis of high-quality RCT evidence with up to one-year follow-up.</p><p><strong>Data sources: </strong>PubMed/MEDLINE, Web of Science, and Scopus databases.</p><p><strong>Study selection: </strong>RCTs involving patients with confirmed LVO and Alberta Stroke Program Early CT Score (ASPECTS) of ≤5, comparing EVT plus MC versus MC alone, with long-term outcome data.</p><p><strong>Data analysis: </strong>Meta-analysis of long-term functional and safety outcomes with subgroup analysis comparing long-term (≤1 year) versus short-term (≤90 days) data on functional outcomes, imaging modalities, and presentation window. Leave-one-out sensitivity analysis was performed to resolve heterogeneity.</p><p><strong>Data synthesis: </strong>Four RCTs comprising 1229 patients (49% female) were included. EVT demonstrated significant superiority over MC in functional independence (mRS0-2) (RR 3.91, 95% CI 2.7-5.66; P<0.001), mortality (RR 0.84, 95% CI 0.75-0.95; P=0.005), overall survival (mRS0-5) (RR 1.17, 95% CI 1.05-1.31; P=0.005), and quality of life (SMD 0.55, 95% CI 0.32-0.8; P<0.001) with up to one-year follow-up. No significant differences in complication rates were observed except for higher extra-cerebral thromboembolic events in the EVT group (RR 7.94, 95% CI 1.01-62.2; P=0.048).</p><p><strong>Limitations: </strong>Study limited to RCT data with potential variations in thrombectomy techniques and patient selection criteria across trials.</p><p><strong>Conclusions: </strong>In patients with ischemic stroke due to LVO with established large core infarct, EVT plus MC showed significant long-term benefits in functional outcomes, survival, and quality of life compared to MC alone.</p><p><strong>Abbreviations: </strong>EVT = endovascular thrombectomy; MC = medical care; LVO = large vessel occlusion; ASPECTS = Alberta Stroke Program Early CT Score; RCTs = randomized controlled trials; RR = risk ratio; CI = confidence interval; SMD = standardized mean difference; mRS = modified Rankin Scale; sICH = symptomatic intracranial hemorrhage; PRISMA = Preferred Reporting Items for Systematic Reviews and Meta-Analyses; HR = hazard ratio; ROB2 = Risk of Bias 2; NIHSS = National Institutes of Health Stroke Scale.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143733550","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":"Enhancing Clarity in Dynamic Myelography Reporting: Results of a Survey of Patients and Referring Providers Evaluating a Standardized Reporting System in the Myelographic Workup of Patients with Suspected Spontaneous Intracranial Hypotension.","authors":"Andrew L Callen, Samantha L Pisani Petrucci, Debayan Bhaumik, Peter Lennarson, Marius Birlea, Jennifer MacKenzie, Jodi Ettenberg, Lalani Carlton Jones","doi":"10.3174/ajnr.A8751","DOIUrl":"10.3174/ajnr.A8751","url":null,"abstract":"<p><strong>Background and purpose: </strong>Dynamic myelography is a critical diagnostic tool for identifying cerebrospinal fluid (CSF) leaks, yet the current lack of standardized reporting can lead to variability in both clinical decision-making and patient understanding. To address these issues, we developed the Spontaneous Intracranial Hypotension Reporting and Data System (SIH-RADS), a standardized scoring system designed to categorize findings on dynamic myelography based on the degree of diagnostic certainty. We then administered a survey to patients and referring providers in order to evaluate the perceived value, clarity, and impact of SIH-RADS on patient and provider experiences as an adjunct to traditional reporting methods for dynamic myelography.</p><p><strong>Materials and methods: </strong>The SIH-RADS scoring system was developed as a collaborative effort between patients and physicians, with six categories ranging from \"Definite Positive with Precise Localization\" (SIH-RADS 5) to \"Technical Failure\" (SIH-RADS 0). Surveys were distributed to three groups: (1) patients who had undergone myelography at our institution for suspected SIH, (2) anonymous patients via private spinal CSF leak groups on social media who had previously undergone myelography, and (3) referring providers who order myelograms for SIH evaluation. Survey questions assessed understanding of traditional reports, clarity of the SIH-RADS system, its impact on decision-making, and preferences for future reporting. Statistical comparisons between local and anonymous patient responses were performed using chi-square tests for categorical variables and t-tests for continuous variables. The observational study STROBE Checklist was utilized, with the proposed methodology followed.</p><p><strong>Results: </strong>A total of 125 patients (78 local patients, 47 anonymous patients) and 13 providers participated in the survey. Among patients, 77% expressed a preference for SIH-RADS over traditional reporting methods, and 58% believed it would improve their understanding of myelography results. Among providers, 92% favored adopting SIH-RADS for future reports, with 85% rating it as very or extremely useful for guiding clinical decisions. 92% of providers reported that the standardized system would enhance communication with patients. Qualitative feedback emphasized the benefits of clearer categorization and actionable recommendations, while also highlighting opportunities to refine patient-facing language and address ambiguities in intermediate scores.</p><p><strong>Conclusions: </strong>A structured reporting system improves the perceived clarity, utility, and communication of dynamic myelography findings among both patients and providers.</p><p><strong>Abbreviations: </strong>CSF = cerebrospinal fluid; SIH = spontaneous intracranial hypotension; CVF = CSF venous fistula.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143733548","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}