AJNR. American journal of neuroradiology最新文献

{"title":"Comparative Safety and Efficacy of Balloon Mounted Stents and Self Expanding Stents in Rescue Stenting for Large Vessel Occlusion: Secondary analysis of the RESCUE-ICAS Registry.","authors":"Sami Al Kasab, Adam T Mierzwa, Imad Samman Tahhan, Shadi Yaghi, Mouhammad Jumaa, Violiza Inoa, Francesco Capasso, Michael Nahhas, Robert M Starke, Isabel Fragata, Matthew T Bender, Krisztina Moldovan, Ilko Maier, Jonathan A Grossberg, Pascal Jabbour, Marios Psychogios, Edgar A Samaniego, Jan-Karl Burkhardt, David Altschul, Justin Mascitelli, Mohamad Ezzeldin, Ramesh Grandhi, Adam de Havenon, Thanh N Nguyen, Ameer E Hassan","doi":"10.3174/ajnr.A8895","DOIUrl":"10.3174/ajnr.A8895","url":null,"abstract":"<p><strong>Background and purpose: </strong>Patients with intracranial stenosis-related large vessel occlusion (ICAS-LVO) may experience better outcomes with stenting compared to standalone mechanical thrombectomy. This study evaluates the safety and clinical outcomes of self-expanding stents (SES) versus balloon-mounted stents (BMS) in ICAS-LVO patients treated with mechanical thrombectomy and stenting.</p><p><strong>Materials and methods: </strong>This secondary analysis of the RESCUE-ICAS registry, a multicenter observational study, included ICASLVO patients from 25 stroke centers who underwent stenting. Patients were stratified by stent type (SES or BMS). The primary endpoint was 90-day modified Rankin Scale (mRS) 0-2. Secondary outcomes included successful reperfusion, recurrent stroke, and infarct volume. Symptomatic intracranial hemorrhage was the primary safety outcome. Inverse probability weighting adjusted for confounders.</p><p><strong>Results: </strong>Among 194 patients, 111 received SES, of whom 61 (55%) underwent pre-stenting angioplasty. After adjustment, no significant difference was observed between SES and BMS in 90-day mRS 0-2 (OR 1.10, 95% CI 0.62-1.96, p=0.75), successful reperfusion (mTICI ≥2B), or final infarct volume. SES was associated with higher odds of moderate stenosis (>50%) at follow-up (OR 3.7, 95% CI 1.15-11.98, p=0.02) and recurrent stroke (13.5% vs. 1.2%, p=0.001), particularly in patients without pre-stenting angioplasty (14% vs. 1%).</p><p><strong>Conclusions: </strong>SES and BMS demonstrated comparable safety and clinical outcomes in ICAS-LVO patients. However, SES was linked to higher rates of restenosis and recurrent strokes, potentially influenced by the absence of pre-stenting angioplasty. Further research is needed to refine stenting strategies in this population.</p><p><strong>Abbreviations: </strong>BMS = balloon mounted stents, ICAS = intracranial atherosclerotic stenosis, IPW = Inverse probability weighted, MT = mechanical thrombectomy, LVO = Large vessel occlusion, RS = rescue stenting, RESCUE-ICAS = Registry of Emergent Large Vessel Occlusion due to Intracranial Stenosis, SES = self-expanding stents (SES).</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144478198","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":"Altered Functional Connectivity and Amyloid Deposition in Posttraumatic Stress Disorder-Associated Cognitive Impairment.","authors":"Richard Dagher, Parisa Arjmand, Daniel A Stevens, Max Wintermark, Haris I Sair, Vivek Yedavalli, Licia P Luna","doi":"10.3174/ajnr.A8694","DOIUrl":"10.3174/ajnr.A8694","url":null,"abstract":"<p><strong>Background and purpose: </strong>Posttraumatic stress disorder (PTSD) has been linked to an increased risk of cognitive impairment and dementia, with neuroinflammation, metabolic dysfunction, and neuropathologic markers such as β-amyloid and τ implicated as potential mechanisms. However, the roles of altered functional connectivity and amyloid deposition as biomarkers in the progression of cognitive impairment among patients with PTSD remain unclear, with limited and often conflicting evidence from existing neuroimaging studies. This study examines these neuroimaging markers in patients with PTSD with and without cognitive impairment to better understand the neurobiologic pathways contributing to cognitive decline in PTSD.</p><p><strong>Materials and methods: </strong>Data were obtained from the Alzheimer's Disease Neuroimaging Initiative (ADNI) and Department of Defense (DOD) databases. A cohort of 178 age-matched male subjects was divided into 4 groups: posttraumatic stress disorder with cognitive impairment (PTSD-CI); posttraumatic stress disorder and cognitively normal (PTSD-CN); non-posttraumatic stress disorder with cognitive impairment (NPTSD-CI); and non-posttraumatic stress disorder and cognitively normal (NPTSD-CN). All subjects underwent resting-state functional MRI and amyloid PET imaging, with PTSD diagnosis and cognitive impairment (CI) confirmed through clinical assessments. Functional connectivity was analyzed by using the CONN Toolbox, and amyloid burden was quantified via standardized uptake value ratios. Analyses controlled for demographic and genetic factors, including age, education, <i>apolipoprotein E4</i> status, and depression.</p><p><strong>Results: </strong>Compared with the NPTSD-CN group, the PTSD-CI group showed significantly increased amyloid uptake in the temporal and parietal lobes, with corresponding functional connectivity increase between the bilateral temporal lobes and parietal operculum. In contrast, PTSD-CN patients exhibited no significant amyloid increase but showed increased connectivity between the salience network, postcentral gyri, and sensorimotor areas, and decreased connectivity between the sensorimotor network and anterior cingulate cortex. These distinct patterns suggest differing neurobiologic profiles between PTSD-CI and PTSD-CN patients.</p><p><strong>Conclusions: </strong>The findings suggest that elevated amyloid and altered connectivity patterns are associated with cognitive impairment in PTSD, particularly in the temporal and parietal regions. In contrast, PTSD without cognitive decline was associated with functional connectivity changes in salience and sensorimotor networks but no increased amyloid deposition. This study underscores the importance of neuroimaging biomarkers in understanding PTSD-related cognitive decline and suggests avenues for further investigation into the mechanistic pathways involved.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143392671","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":"Outcomes of Radiologist Recommendations for Temporal Bone CT to Assess Superior Semicircular Canal Dehiscence on Temporal Bone MRI.","authors":"Pejman Rabiei, Jisoo Kim, Amir A Satani, C Eduardo Corrales, Ronilda Lacson, Ramin Khorasani, Jeffrey P Guenette","doi":"10.3174/ajnr.A8691","DOIUrl":"10.3174/ajnr.A8691","url":null,"abstract":"<p><strong>Background and purpose: </strong>Superior semicircular canal dehiscence (SSCD) can be detected on temporal bone MR images. Radiologists often recommend confirmation with temporal bone CT because of reported lower MRI positive predictive value. The value of these recommendations is unclear, given that CT overestimates dehiscence due to volume averaging and that only a small proportion of patients with dehiscence on CT suffer from dehiscence syndrome. We thus evaluated final diagnoses and outcomes in patients who adhered to the recommended additional CT.</p><p><strong>Materials and methods: </strong>This retrospective cohort observational study, performed at a multi-institution health care system, included consecutive temporal bone MRI reports from June 1, 2021, through May 31, 2022, with a recommendation for additional temporal bone CT. We recorded whether CT was performed, dehiscence present on CT, symptoms, final diagnosis, treatment decisions, and outcomes. Actionability elements (complete containing imaging technique, timeframe, and rationale; unambiguous; unconditional; without multiplicity; and without alternate language) of the recommendations were extracted from a prior data set. Descriptive statistics were performed. A binomial generalized linear model was used to test the correlation of ambiguous recommendation language with recommendation adherence.</p><p><strong>Results: </strong>There were 5109 temporal bone MRI examinations performed and interpreted by 34 radiologists. One hundred eighty-seven of the 5109 reports (3.7%) included a recommendation for additional temporal bone CT including 101/5109 (2.0%) specifically for suspected SSCD. While 22% (22/101) of these recommended examinations were performed, only 32% of these (7/22) confirmed dehiscence. Ultimately, only 1 patient was diagnosed with dehiscence syndrome and was managed conservatively. No recommendations for additional imaging (0/101) met actionable criteria and 76.2% (77/101) were ambiguous. Ambiguous recommendations had 0.54 lower, but not statistically significant, odds of being performed (95% CI: 0.19-1.6, <i>P</i> = .25).</p><p><strong>Conclusions: </strong>Radiologist recommendations for temporal bone CT in the setting of questionable SSCD findings on MRI appear to have negligible clinical value. Thus, it is likely most appropriate to report possible SSCD in the MRI report impression without recommending further imaging.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143257504","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advanced Imaging of Type 2 Spinal CSF Leaks with Ultra-High-Resolution Conebeam CT Myelography.","authors":"Niklas Lützen, Charlotte Zander, Jürgen Beck, Florian Volz, Katharina Wolf, Amir El Rahal, Horst Urbach","doi":"10.3174/ajnr.A8675","DOIUrl":"10.3174/ajnr.A8675","url":null,"abstract":"<p><p>Type 2 CSF leaks are spinal lateral dural tears, causing spontaneous intracranial hypotension. They may be visualized with digital subtraction myelography, conebeam CT myelography, and energy-integrating detector or photon-counting CT myelography. A recently introduced ultra-high-resolution conebeam CT myelography has shown beneficial visualization of CSF-venous fistulas, another cause of spontaneous intracranial hypotension. However, the use of this technique has not yet been reported in imaging of type 2 leaks. In this technical report, we describe our first experiences and highlight the advantages of ultra-high-resolution conebeam CT for visualizing type 2 leaks in spontaneous intracranial hypotension.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143069501","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pediatric-type diffuse low-grade gliomas with MYB alterations: Neuroimaging of the Diffuse astrocytomas, <i>MYB</i> or <i>MYBL1</i>-altered.","authors":"Fiorenza Coppola, Brigitte Bison, Anna Tietze, Volodia Dangouloff-Ros, Maarten Lequin, Sniya Sudhakar, Thomas S Jacques, Maarit Palomäki, Cesar Ap Alves, Kshitij Mankad, Pablo Hernáiz Driever, Svea Horn, Lars Behrens, Darren R Hargrave, Giovanni Morana, Ulrike Löbel","doi":"10.3174/ajnr.A8894","DOIUrl":"https://doi.org/10.3174/ajnr.A8894","url":null,"abstract":"<p><strong>Background and purpose: </strong>Diffuse astrocytoma, MYB or MYBL1-altered is a new tumor type in the family of Pediatric-type diffuse low-grade gliomas and genetically related to angiocentric glioma. Imaging features of Diffuse astrocytoma, MYB or MYBL1-altered are less well known. During our clinical work, we identified a relatively characteristic imaging pattern in a subset of our patients consisting of a large, diffuse hemispheric tumor with displaced central vessels which we termed the \"fireworks sign\". Therefore, the purpose of this work was to describe the frequency of this sign and any additional imaging characteristics in a large patient cohort.</p><p><strong>Materials and methods: </strong>This international retrospective study included 40 patients from 7 countries. We recorded clinical, genetic and standard radiological features focusing on the presence of the \"fireworks sign\" but also the presence or absence of a mismatch between T2WI and FLAIR and a FLAIR rim which have both been reported in these patients.</p><p><strong>Results: </strong>Most tumors were unilateral and located in the cerebral hemispheres (most frequently in parietal, temporal and frontal lobes), hypointense on T1WI and hyperintense on T2WI. No tumor showed diffusion restriction. The \"fireworks sign\" was present in 16 patients. Other features included: T2/FLAIR mismatch (24 cases), FLAIR rim (18 cases), necrosis (5 cases) and enhancement (5 cases). Tumor volume was significantly associated with the \"fireworks sign\" (p=0.01) and T2/FLAIR mismatch (p=0.005).</p><p><strong>Conclusions: </strong>Imaging features of Diffuse astrocytoma, MYB1 or MYBL1-altered in children are variable and the \"fireworks sign\" was identified in a subset of patients only. It was usually present in patients with large hemispheric tumors but also observed in brainstem lesions. Diffusion restriction was consistently absent and enhancement infrequent. A T2/FLAIR mismatch was seen in more than 50% of patients.</p><p><strong>Abbreviations: </strong>WHO = World Health Organization; DA-MYB = Diffuse astrocytoma, <i>MYB</i> or <i>MYBL1-altered</i>.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144487419","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":"Pituitary Photon Counting Detector CT for Cushing Disease: Pre-operative Lesion Localization, Intraoperative Findings, and Post-operative Outcomes.","authors":"Ian T Mark, Giorgos Michalopoulos, Jamie Van Gompel, Maria Peris Celda, Irina Bancos, Diane Donegan, Lucinda M Gruber, Dana Erickson, Alex A Nagelschneider, Lifeng Yu","doi":"10.3174/ajnr.A8893","DOIUrl":"https://doi.org/10.3174/ajnr.A8893","url":null,"abstract":"<p><strong>Background and purpose: </strong>MRI fails to localize a tumor in up to 40% of cases of ACTH dependent Cushing Disease (CD), impacting patient outcomes and creating uncertainty in the diagnosis. Photon-counting detector CT (PCD-CT) is a new CT technology with better imaging performance than conventional CT. PCD-CT is a novel imaging technique for CD, especially for MR-negative cases, however its application to CD remains unknown.</p><p><strong>Materials and methods: </strong>We present a cohort of consecutive patients with a pre-operative PCD-CT undergoing transsphenoidal surgery for CD at a single institution from September 2023 to January 2025. All patients underwent gadolinium-enhanced pituitary MRI for baseline work-up and PCD-CT as part of their preoperative planning imaging. Both imaging modalities were used to localize the lesion and guide surgical planning. The accuracies of MRI and PCD-CT were based on confirmation of the lesion location by a combination of intraoperative visualization, pathologic confirmation, and postoperative biochemical remission, and were compared with each other via Fisher's exact test.</p><p><strong>Results: </strong>Twenty-five patients with CD were included in this analysis. The cohort's median age was 50 years old, and 88% were female. At diagnosis, 88% had central obesity, 76% had hypertension, 48% had type II diabetes mellitus, and 20% had osteoporosis. Contrast-enhanced MRI accurately identified 56% of lesions, while it was negative in 24% and misleading in 20%. Dynamic contrast-enhanced PCD-CT was superior in localizing CD (p=0.01), accurately identifying 92% of lesions, while it was negative in 4% and misleading in 4% of cases. Early postoperative biochemical remission was achieved in 88% of cases, while 84% remained in remission at follow-up.</p><p><strong>Conclusions: </strong>PCD-CT had a high rate of adenoma localization confirmed intraoperatively, even among MR-negative cases, potentially leading to high remission and gland preservation rates. Its role in the clinical workflow of preoperative evaluation for CD requires further investigation, but current evidence supports its value in lesion localization, especially in MR-negative disease.</p><p><strong>Abbreviations: </strong>CD＝ cushing disease; PCD＝ photon counting detector.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144478209","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":"Irregular Cervicothoracic Nerve Sheaths on Digital Subtraction Myelography: A CSF-Venous Fistula Mimic.","authors":"Asmita S Patel, John C Benson, Waleed Brinjikji, Ben A Johnson-Tesch, Ajay A Madhavan, Jared T Verdoorn, Ian T Mark","doi":"10.3174/ajnr.A8892","DOIUrl":"https://doi.org/10.3174/ajnr.A8892","url":null,"abstract":"<p><strong>Background and purpose: </strong>Spontaneous intracranial hypotension (SIH) can be caused by cerebrospinal fluid-venous fistulas (CVFs), which often require a specialized lateral decubitus exam such as digital subtraction myelography (DSM) for diagnosis. DSM interpretations can be confounded by irregular nerve sheath diverticula at the cervicothoracic junction, potentially mimicking a true CVF. This study aimed to characterize anatomic variations of nerve sheaths at the cervicothoracic junction, in effort to reduce the risk of misdiagnosis.</p><p><strong>Materials and methods: </strong>We retrospectively identified 35 patients with low-risk Bern scores who were negative for CVF on DSM. Nerve sheaths at C6-C7, C7-T1, and T1-T2 were classified as normal (<5 mm), elongated linear (≥5 mm), linear-bulbous, linear-branching, or diverticular. Results were obtained on both the left and right side for each patient.</p><p><strong>Results: </strong>Data was obtained for 34 patients. Among these, 74% (25/34) demonstrated at least one variant nerve sheath configuration. The most common site of variation was C7-T1 on the right (seen in 55%, 18/33), and the most frequent morphologic variant overall was an elongated linear sheath (28/198 levels; 40% of all variants).</p><p><strong>Conclusions: </strong>Nerve sheath morphology at the cervicothoracic junction is frequently irregular, and these variants can resemble a CVF on DSM. Recognizing such normal anatomic variations is essential to avoid unwarranted interventions for suspected CVF in patients evaluated for SIH.</p><p><strong>Abbreviations: </strong>CV<b>F</b> = CSF-venous fistula, <b>DSM</b> = Digital subtraction myelography, <b>SIH</b>＝ Spontaneous intracranial hypotension.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144478208","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":"Innovative Educational Program to Aid Clinical Vessel Wall MR Imaging Interpretation Among Neuroradiologists.","authors":"Jae W Song, Ronald L Wolf, Alvand Hassankhani, John H Woo, Robert M Kurtz, Jeffrey B Ware, Colbey Freeman, Suehyb G Alkhatib, Lori Y Huang, Sriharsha Voleti, Kyle Gottschling, Laurie A Loevner","doi":"10.3174/ajnr.A8891","DOIUrl":"https://doi.org/10.3174/ajnr.A8891","url":null,"abstract":"<p><p>Innovations that introduce new knowledge domains face greater barriers to adoption, often requiring investment in infrastructure, training/education and cultural change. Sustaining and scaling an advanced clinical vessel wall MR imaging program requires technical resources and sub-specialized neuroradiologists with advanced cerebrovascular expertise. A multifaceted educational program, including lectures, reporting templates and an online resource, was implemented within a large academic neuroradiology division to address neuroradiology workforce readiness. Seven neuroradiology faculty \"super-users\" interested in cerebrovascular imaging were identified to facilitate case discussions and provide daily support for colleagues, clinicians, and MR technologists. Impact was assessed through a 12-month pre-/post-intervention survey measuring confidence levels in (a) evaluating VWI exam appropriateness, (b) assessing image quality, and (c) diagnostic interpretations. Results showed division-wide increases in self-reported confidence and statistically significant increases among the super-users. These results show that a structured, expert-led peer-support model can enhance clinical readiness and sustain advanced imaging programs.ABBREVIATIONS: VWI＝ vessel wall magnetic resonance imaging.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144478199","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":"Why 2D Matters: Comparative Evaluation of 2D and 3D T1-Weighted Imaging of the Skull Base and Neck.","authors":"Amy F Juliano, Nathan Huey, Laura V Romo, Hillary R Kelly, Manuel Patino, Yuh-Shin Chang, Paul Couto, Marcela Marsiglia, Jarrel Seah, Sebastian F Juliano, Katherine L Reinshagen","doi":"10.3174/ajnr.A8887","DOIUrl":"10.3174/ajnr.A8887","url":null,"abstract":"<p><strong>Background and purpose: </strong>3-dimensional (3D) T1-weighted imaging (T1-WI) MR protocols have been proposed as time-efficient alternatives for skull base and neck imaging, but direct comparisons with conventional 2-dimensional (2D) T1-weighted turbo spin echo (TSE) imaging are limited. This study aims to qualitatively and quantitatively compare 2D and 3D T1-WI of the head and neck.</p><p><strong>Materials and methods: </strong>A retrospective review was conducted on 21 patients who underwent both 2D and 3D pre-and post-contrast T1-WI during the same scan session (3T Philips 7700). Seven independent radiologists (4.5-35-years experience) evaluated image quality using Likert scales, categorical ratings (2D better, 3D better, equivalent), and yes/no questions. Quantitative measures included ROI intensity values in buccal fat, masseter muscle, and tumors (if present), as well as percent delineation of two small but relevant muscles, tensor veli palatini and superior pharyngeal constrictor muscles on skull base and neck MR, respectively.</p><p><strong>Results: </strong>Of the 21 MRIs (10 skull base, 11 neck), contrast timing was balanced across sequences. Raters significantly favored 2D T1-weighted TSE for improved fat visualization at skull base foramina, homogeneity of fat signal, and parotid architecture (p<.001). Tumor margins were more clearly defined on 2D neck MR (pre-and post-contrast: p<.001, p=.04), although this was not significantly different at the skull base. 3D sequences showed less pulsation artifact particularly pre-contrast (both p<.001), but more susceptibility artifact (both, p<.001). Quantitatively, 2D images had higher fat-to-muscle (both p<.001) and tumor-to-muscle relative signal intensity ratios (neck: p<.001, skull base: p=.04). Delineation of tensor veli palatini and superior pharyngeal constrictor muscles was significantly better with 2D imaging (both p<.001). Multiplanar reformat capability from 3D imaging did not add diagnostic value in either the neck or skull base (all p<.05).</p><p><strong>Conclusions: </strong>Despite advances in 3D imaging, 2D T1-weighted TSE sequences continue to offer superior soft tissue contrast and delineation in the complex anatomy of the skull base and neck. While 3D sequences reduce pulsation artifacts and provide thinner slices, their overall diagnostic utility remains less favorable due to poorer tissue contrast and increased susceptibility artifacts particularly at tissue interfaces, especially relevant in the head and neck.</p><p><strong>Abbreviations: </strong>TSE=turbo spin echo, TFE= turbo field echo, ROI=region-of-interest, 2D=2-dimension, 3D=3-dimension, mDixon=modified Dixon, T1-WI=T1-weighted image, MPR=multiplanar reformat.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144337255","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":"Association of Cerebellar Peduncle Morphometry with Hypertrophic Olivary Degeneration: A Pilot Case-Control Study.","authors":"Koustav Ghosal, Sumit Thakar, Sunitha P Kumaran, Saritha Aryan","doi":"10.3174/ajnr.A8888","DOIUrl":"10.3174/ajnr.A8888","url":null,"abstract":"<p><strong>Background and purpose: </strong>Hypertrophic olivary degeneration (HOD) is a rare neurological condition resulting from disruption of the dentato-rubro-olivary pathway (DROP). Nearly half the HOD cases, however, lack detectable lesions in the DROP, and fewer than 10% of patients develop the condition following surgical resection of posterior fossa tumors. Based on these observations, we hypothesized that inherent anatomical variations in components of the DROP -specifically the inferior cerebellar peduncle (ICP) and superior cerebellar peduncle (SCP) -may predict susceptibility to HOD.</p><p><strong>Materials and methods: </strong>This retrospective pilot case-control study included 12 patients who developed unilateral HOD following maximal safe resection of midline posterior fossa tumors and 24 matched controls who underwent tumor resection via the same standardized surgical approach but did not develop HOD. Morphometric measurements of the ICP and SCP were obtained from T2-weighted MRI and recorded as ratios to brainstem width (ICP/medulla, SCP/midbrain). Group comparisons were performed using independent t-tests, and effect sizes were calculated. Receiver operating characteristic analysis assessed the predictive accuracy of these ratios, while logistic regression and bootstrap resampling (10,000 iterations) were used to assess robustness and reproducibility.</p><p><strong>Results: </strong>The ICP/medulla ratio was significantly lower in HOD cases (0.40 ± 0.04) than in controls (0.47 ± 0.06, p = 0.01), while the SCP/midbrain ratio showed no significant difference (p = 0.78). Effect size analysis indicated a large difference between groups (Cohen's d = -1.14). Receiver operating characteristic analysis demonstrated good predictive accuracy for the ICP/medulla ratio (area under the curve = 0.80, 95% CI, 0.64-0.92). Logistic regression confirmed a significant association between a smaller ICP/medulla ratio and increased HOD risk (p = 0.01). Bootstrap resampling reinforced the reliability of these findings (mean regression coefficient = -30.78, 95% CI: -61.59 to -12.70).</p><p><strong>Conclusions: </strong>This pilot study suggests that smaller ICP/medulla ratios are associated with a higher likelihood of developing HOD following posterior fossa tumor resection. While preliminary, this novel finding highlights the possible role of these measurements in enhancing preoperative risk assessment.</p><p><strong>Abbreviations: </strong>DROP = dentato-rubro-olivary pathway; HOD = hypertrophic olivary degeneration; ICP = inferior cerebellar peduncle; ION = inferior olivary nucleus; SCP = superior cerebellar peduncle.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144337252","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}