AJNR. American journal of neuroradiology最新文献

{"title":"Using Data-Driven Methods to Improve Brain Blood Flow Measurements in Cerebrovascular Disease with Dynamic Imaging.","authors":"Siddhant Dogra, Xiuyuan Wang, James Michael Gee, Yihui Zhu, Koto Ishida, Seena Dehkharghani","doi":"10.3174/ajnr.A8813","DOIUrl":"10.3174/ajnr.A8813","url":null,"abstract":"<p><strong>Background and purpose: </strong>Cerebrovascular reactivity (CVR) is a widely studied biomarker of cerebral hemodynamics, commonly used in risk stratification and treatment planning in patients with steno-occlusive disease (SOD). Conventional use relies on normalization of estimates to contralateral hemisphere reference values, which is unsuitable for bilateral or indeterminate distributions of disease. We report upon a custom data-driven approach leveraging random forest classifiers (RFc) to identify candidate voxels for normalization to facilitate interrogation outside conditions of known unilateral SOD.</p><p><strong>Materials and methods: </strong>We retrospectively analyzed 16 patients with unilateral SOD who underwent acetazolamide-augmented blood oxygen level- dependent-MRI and DSC perfusion. Three RFc models were trained by using leave-one-out cross-validation (LOOCV) to identify candidate voxels brain-wide whose CVR was within 10% of the normal hemispheric median: 1) all voxels; 2) gray matter only; and 3) white matter only. Model input features included time-to-maximum, mean transit time, CBF, and CBV from contemporaneous DSC. The median model-predicted reference cerebrovascular reactivity (CVRref) was compared with ground-truth medians in LOOCV, and its impact on threshold-based volumetric classification of CVR reduction assessed.</p><p><strong>Results: </strong>RFc models effectively predicted ground-truth CVR voxels, achieving median absolute percent differences of 12.8% (interquartile range [IQR]: 5.0%-18.9%) by using all voxels, 11.3% (IQR: 9.3%-16.1%) for gray matter, and 9.8% (IQR: 4.4%-16.9%) for white matter. Volumetric estimates of CVR reduction across thresholds for the models revealed excellent agreement between ground-truth and model estimates without statistically significant differences (<i>P</i> > .01), excepting lowest white matter CVR thresholds. Model use in a small pilot deployment of bilateral SOD cases demonstrated the potential utility, enabling voxelwise CVR assessment without reliance on contralateral reference.</p><p><strong>Conclusions: </strong>We present a novel data-driven approach for normalizing CVR maps in patients with bilateral or indeterminate SOD. Using an RFc, our method provides an individualized, brain-wide reference CVR, expanding the utility of CVR estimates beyond the typical constraints of unilateral disease, and with potential application to other, similarly constrained scenarios such as for SPECT or PET hemodynamic studies.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144053422","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":"Progressive and short-interval changes observed in the corticospinal tract and corpus callosum of ALS patients: A texture analysis study.","authors":"Pedram Parnianpour, Matthew Harrison, Michael Benatar, Hannah Briemberg, Annie Dionne, Nicolas Dupré, Richard Frayne, Angela Genge, Simon J Graham, Lawrence Korngut, Peter Seres, Alan Wilman, Lorne Zinman, Sanjay Kalra","doi":"10.3174/ajnr.A9013","DOIUrl":"https://doi.org/10.3174/ajnr.A9013","url":null,"abstract":"<p><strong>Background and purpose: </strong>Diffusion magnetic resonance imaging (MRI) measures indicative of white matter integrity have consistently been shown to be altered in the state of the corticospinal tract and corpus callosum of patients with amyotrophic lateral sclerosis (ALS). However, diffusion MRI acquisitions are not routinely collected as part of the standard medical imaging of ALS patients. T1-weighted MRI scans are commonly available in the clinical assessment of most ALS patients. While visual inspection of these scans reveals little about the cerebral pathology of ALS, analysis of their textural patterns has identified disease-related abnormalities in patients at various stages of the disease. The present study aimed to examine the spatial and temporal profile of corticospinal tract and corpus callosum degeneration in ALS patients using texture analysis of T1-weighted MRI scans obtained at baseline and at four-and eight-month follow-ups.</p><p><strong>Materials and methods: </strong>The study involved data from 64 ALS patients and 83 healthy controls who participated in the multicenter Canadian ALS Neuroimaging Consortium (CALSNIC) project. The texture feature \"autocorrelation\" was quantified along the superior-inferior course of the corticospinal tract and along the anterior-posterior direction of the corpus callosum of participants.</p><p><strong>Results: </strong>Progressive textural changes were observed within the bilateral corticospinal tract, particularly in the primary motor cortex region, posterior limb of the internal capsule, and the cerebral peduncle. As the disease progressed, significant textural changes developed in the middle and anterior parts of the corpus callosum. Autocorrelation values in these regions correlated with the degree of upper motor neuron dysfunction on neurological examination.</p><p><strong>Conclusions: </strong>Progressive corticospinal tract and corpus callosum degeneration was characterized in ALS using a novel imaging texture analysis approach, with changes observed over an interval of 4 months.</p><p><strong>Abbreviations: </strong>ALS＝ Amyotrophic lateral sclerosis; CST＝ corticospinal tract; CC = corpus callosum; ALSFRS-R= ALS functional rating scale-revised; CALSNIC = Canadian ALS Neuroimaging Consortium; DPR = disease progression rate; ECAS = Edinburgh Cognitive and Behavioral ALS Screen; HC = healthy control; FDR = false discovery rate; UMN = upper motor neurons.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145088189","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":"Hybrid [¹⁸F] Fluoroestradiol Brain PET/CT/MRI for Detection of Estrogen Receptor-Positive Intracranial Metastases Compared with MRI and Vertex-to-Below the Knees PET Imaging.","authors":"Faizullah Mashriqi, Michelle Chen, Graham Keir, Chris Caravella, Anuj Goenka, Sean A P Clouston, Josephine Rini, Ana M Franceschi","doi":"10.3174/ajnr.A8863","DOIUrl":"https://doi.org/10.3174/ajnr.A8863","url":null,"abstract":"<p><strong>Background and purpose: </strong>[¹⁸F]-fluoroestradiol (FES) is a novel molecular imaging radiopharmaceutical that has demonstrated promise in the staging of ER-positive brain metastases. Our aim was to determine if hybrid [¹⁸F] FES brain PET/MRI is superior to conventional brain MRI alone for detecting estrogen receptor (ER)-positive brain and calvarial metastases, compare limited [¹⁸F] FES brain PET with vertex-to-below the knees [¹⁸F] FES PET results, and determine the impact of [¹⁸F] FES brain PET/MRI on patient management decisions.</p><p><strong>Materials and methods: </strong>Following institutional review board approval, a retrospective analysis was conducted of patients who underwent [¹⁸F] FES brain PET/CT and contrast-enhanced brain MRI at our institution from January 2024 to November 2024. Intracranial lesions, including parenchymal, dural-based, calvarial, leptomeningeal, and extracranial soft tissue/scalp, were analyzed by an expert neuroradiologist using fused [¹⁸F] FES brain PET/MRI, and lesion size, location, and maximum standard uptake value were recorded. Two radiology residents reviewed separately acquired contrast-enhanced brain MRI reports and documented the number and location of intracranial lesions. A nuclear medicine physician reviewed vertex-to-below the knees [¹⁸F] FES PET/CT and reported the intracranial lesion number and maximum standard uptake value.</p><p><strong>Results: </strong>Ten female patients with ER-positive breast cancer with 90 metastatic brain and calvarial lesions were included in our analysis. The mean age was 64.3 (SD, 7.5) years. Twelve of 90 (13.3%) lesions were occult on contrast-enhanced brain MRI but detected by ¹⁸F-FES brain PET/MRI, including 1 parenchymal lesion, 8/19 (42.1%) calvarial lesions, and 5/6 (50.0%) extracranial soft-tissue/scalp lesions. Meanwhile, 16/90 (17.8%) lesions were occult on vertex-to-thigh ¹⁸F-FES PET/CT compared with [¹⁸F] FES brain PET/MRI, including 13/58 (22.4%) parenchymal lesions and 3/7 (42.9%) dural-based lesions. There was a modification in patient management for 9 of 10 patients (90%) following the [¹⁸F] FES brain PET/MRI.</p><p><strong>Conclusions: </strong>By integrating [¹⁸F] FES brain PET/CT/MRI into our clinical workflow, we improved the detection of ER-positive lesions, resulting in a substantial impact on clinical management decisions.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145088215","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":"Choroid Plexus Enlargement in Multiple Sclerosis Correlates with Cortical and Phase Rim lesions on 7-T MRI and Predicts Progression Independent of Relapse Activity.","authors":"Elena Barbuti, Allegra Conti, Constantina A Treaba, Alessandro Miscioscia, Valeria T Barletta, Elena Herranz, Jacob A Sloane, Eric C Klawiter, Nicola Toschi, Caterina Mainero","doi":"10.3174/ajnr.A8983","DOIUrl":"10.3174/ajnr.A8983","url":null,"abstract":"<p><strong>Background and purpose: </strong>In multiple sclerosis (MS), the choroid plexus is thought to promote and sustain the disease immunopathological inflammatory process. However, its association with cortical pathology and disease progression is still uncertain. We aim to characterize choroid plexus enlargement and evolution in MS, its relationship with imaging markers of compartmentalized inflammation and clinical outcome.</p><p><strong>Materials and methods: </strong>One-hundred MS patients (74 relapsing-remitting, 26 secondary progressive, RRMS, SPMS) and 41 matched healthy controls (HC) underwent 3-T MRI to measure brain volumes and 7-T MRI for cortical and WM lesions, including paramagnetic rim lesions (PRL), segmentation. Choroid plexus volumes of the lateral ventricles were manually edited from FreeSurfer segmentation by one neurologist and normalized by total intracranial volume to estimate choroid plexus ratio (CPR). Expanded Disability Status Scale was assessed at baseline and longitudinally in 71 patients, 43 of whom had a follow-up MRI at 1.5 years. An extreme gradient boosting algorithm estimated the importance of CPR, alongside other imaging markers, in predicting disease phenotype (RRMS vs SPMS) and Progression Independent of Relapse Activity (PIRA).</p><p><strong>Results: </strong>Relative to HC, CPR was higher in patients (11.66 (3.21) vs 14.98 (4.37) x 10^-4, p=0.001), both in RRMS and SPMS (p=0.007, p=0.003), and there was mean ∼4% increase per year in CPR at follow-up, though not significant (p=0.14). Choroid plexus enlargement correlated with greater PRL and cortical lesion volumes (r=0.35, p<0.001). CPR did not discriminate MS phenotype but predicted PIRA alongside cerebrospinal fluid subarachnoid space volume, PRL and cortical lesion volumes (median (median absolute deviation) area under the curve 0.71 (0.12), accuracy 0.74 (0.10), sensitivity 0.81 (0.12), specificity of 0.52 (0.22)).</p><p><strong>Conclusions: </strong>In MS, CPR increase relates to imaging markers of compartmentalized disease activity including cortical lesions and PRL and is a critical predictor of disease progression. Our findings could provide the rationale for implementing CPR estimation for prognosis prediction in MS.</p><p><strong>Abbreviations: </strong>MS, multiple sclerosis, HC, healthy controls, PRL, paramagnetic rim lesions, CPR, choroid plexus ratio, PIRA, progression independent of relapse activity, RRMS, relapsing-remitting MS, SPMS, secondary progressive MS, XGBoost, extreme gradient boosting, EDSS, Expanded Disability Status Scale, CDP, confirmed disability progression.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144982127","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 Emerging Pediatric CNS Tumor: Imaging Evaluation of <i>H3K27M</i> and <i>BRAF V600E</i> Comutated Midline Tumors.","authors":"Vanessa Rameh, Loai Aker, S Vajapeyam, A Ziaei, Kee Kiat Yeo, Cesar Alves, Lissa C Baird, Katie P Fehnel, Karen Wright, Susan Chi, Hart G Lidov, Sanda Alexandrescu, Tina Y Poussaint","doi":"10.3174/ajnr.A9006","DOIUrl":"https://doi.org/10.3174/ajnr.A9006","url":null,"abstract":"<p><strong>Background and purpose: </strong>Diffuse midline gliomas (DMG) with concurrent <i>H3K27M</i> and <i>BRAF V600E</i> mutations represent a rare and poorly studied subset of pediatric central nervous system tumors. While traditionally associated with poor prognosis, recent evidence suggests that MAPK pathway alterations may confer improved outcomes in select cases. This study aims to explore the imaging characteristics of <i>H3K27M/BRAF V600E</i> coaltered midline gliomas.</p><p><strong>Materials and methods: </strong>Eight pediatric patients (6 males, 2 females; age range: 3-18 years, mean: 11 years) with <i>H3K27M/BRAFV600E</i>-mutant midline tumors were retrospectively reviewed. Data collected included MR imaging features, histopathologic and molecular data, treatment, and follow-up outcomes.</p><p><strong>Results: </strong>Of the eight patients identified, six (n=6/8; 75%) were thalamic, with the remainder involving the hypothalamus/optic pathway and cervical spine. Tumors demonstrated heterogeneous histology: pediatric-type low-grade glioma-like (n=3), ganglioglioma-like (n=3), and high-grade glioma-like (n=2).All tumors were midline in location. Thalamic tumors were well-demarcated but demonstrated infiltrative and exophytic components, with frequent involvement of the third ventricle (n=4/6;66.7%) and internal capsule (n=4/6;66.7%). Imaging demonstrated heterogeneous T1/T2 signal with coarse calcifications in five of thalamic tumors. Hydrocephalus was present in all patients with thalamic lesions. These tumors demonstrated varied diffusion characteristics with areas of intermediate and reduced diffusivity. Enhancement was present but heterogeneous across tumor types. Both HGG-like tumors presented with cranial and spinal leptomeningeal metastases.</p><p><strong>Conclusions: </strong>DMGs harboring both <i>H3K27M</i> and <i>BRAFV600E</i> mutations may represent a distinct subtype, with radiologic, histopathologic, and molecular features that appear different from those of non-MAPK-altered H3K27M DMGs.</p><p><strong>Abbreviations: </strong>World Health Organization = WHO, Diffuse midline glioma = DMG, Mitogen-activated protein kinase = MAPK, Formalin-fixed paraffin-embedded = FFPE, Wild-type = WT, Overall survival = OS, Contrast-enhanced = CE, High-grade gliomas = HGGs, Long-term survival = LTS, Short-term survival= STS.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145082695","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":"Risk Factors for Spinal Cord Compression on MRI in Oncology: Enhancing Diagnostic Yield.","authors":"Onur Yildirim, Burcin Agridag Ucpinar, Luca Pasquini, Elena Yllera Contreras, Julio Arevalo Perez, Akash Shah, Javin Schefflein, Joe Stember, Charlie White, Zhigang Zhang, Adam D Klotz, Andrei I Holodny, Vaios Hatzoglou","doi":"10.3174/ajnr.A9002","DOIUrl":"https://doi.org/10.3174/ajnr.A9002","url":null,"abstract":"<p><strong>Background and purpose: </strong>Epidural spinal cord compression (ESCC) is an important cause of disability among cancer patients. Early detection is crucial for optimizing clinical outcomes. MRI is the preferred imaging modality for ruling out ESCC and frequently requested in radiology departments, particularly in the emergent setting. However, data on the efficacy and diagnostic yield of total spine MRI for diagnosis of ESCC in oncology patients remain limited. This study evaluates the frequency of positive findings and associated risk factors in a tertiary cancer center.</p><p><strong>Materials and methods: </strong>This retrospective study included patients who underwent total spine MRI for assessment of ESCC over a 3-year period. A standardized non-contrast MRI protocol was utilized. Clinical and imaging data, including patient demographics (sex, age), tumor pathology, tumor-node-metastasis (TNM) stage, ESCC grade, symptoms, prior treatments (radiotherapy, surgery, chemotherapy), and ordering physician/department, were retrospectively reviewed. Patients were categorized into 2 groups based on presence or absence of cord compression (ESCC 2 or 3). Associations between ESCC and other variables were assessed via Wilcoxon rank sum test, Pearson's chi-squared test, and Fisher's exact test. Statistical significance was defined as p < 0.05.</p><p><strong>Results: </strong>Among 289 patients (median age 66 years, 148 females) and 300 total spine MRI examinations, ESCC was detected in 18 cases (6.0%). Significant associations with ESCC included advanced TNM stage (p = 0.03) and prior treatments, such as radiation to the site of compression (p = 0.002), decompression surgery (p = 0.01), and recent systemic chemotherapy (p < 0.001). Bone metastases to the spine on body CT exams performed within 2 weeks prior to MRI also correlated with ESCC (p < 0.001). Notably, no ESCC cases occurred in patients without spine bone metastases on recent body CT, or in those with less than stage IV disease. Patient symptoms did not correlate with ESCC presence (p = 0.3).</p><p><strong>Conclusions: </strong>This study suggests that the diagnostic yield of total spine MRI for ESCC in oncology patients is relatively low and may be improved by refining selection criteria. Patients with advanced-stage disease, prior spinal interventions, and bone metastases on recent body CT may be at higher risk.</p><p><strong>Abbreviations: </strong>Epidural spinal cord compression (ESCC), tumor-node-metastasis (TNM).</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145082737","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":"Does Size, Shape, or Location Limit the Central Halo and the Polar Phase Signals of Susceptibility-Weighted Imaging in Differentiating Intracranial Hemorrhages from Calcifications?","authors":"Adrija Krishnamoorthy, Einat Slonimsky, Scott N Hwang, Jonathon K Maffie","doi":"10.3174/ajnr.A9005","DOIUrl":"https://doi.org/10.3174/ajnr.A9005","url":null,"abstract":"<p><strong>Background and purpose: </strong>Evaluation of polar phase signals on susceptibility-weighted imaging (SWI) has shown success in differentiating hemorrhage from calcification, particularly in subcentimeter spherical foci located in the brain. However, aliasing of phase signals near the center of larger susceptibility lesions presents a challenge in accurately classifying lesions with signal dropout and blooming on SWI. We have investigated the use of central halo, in addition to the polar signals, to broaden the use of SWI phase images in classifying lesions with a wider range of locations, sizes, and shapes.</p><p><strong>Materials and methods: </strong>This retrospective study included 50 consecutive patients who underwent MRI with SWI of the brain. Phase signals from the two polar regions and the central halo were evaluated. Susceptibility foci of all sizes, shapes, and locations were included, except for the basal ganglia calcifications. CT images were used as the gold standard for differentiating hemorrhages from calcifications. Appropriate statistical analyses were performed.</p><p><strong>Results: </strong>The study cohort included 22 males and 28 females aged 2-90 years (mean age: 61.19 ± 21.13 years). SWI identified 406 hemorrhages: 305 intraparenchymal, 45 subdural, 22 subarachnoid, 15 intraventricular, and 19 cortical vein thromboses. There were 202 calcifications observed on SWI: 24 intraparenchymal, 41 pineal, 83 choroid plexus, 18 dural, and 36 arachnoid granulations. Hemorrhage sizes ranged from 1.5 mm to 145.2 mm (mean: 11.5 ± 15.81 mm), while calcifications ranged from 1.5 mm to 71.9 mm (mean: 8.16 ± 7.13 mm). Hemorrhagic lesions were round (300), linear (75), or irregular (31), while calcifications were round (139), linear (95), or irregular (1). Sensitivity and specificity for hemorrhages were 99.5% (95% CI: 98.23-99.4) and 100% (95% CI: 98.06- 100), respectively. For calcifications, sensitivity was 84.26% (95% CI: 78.96-88.67) and specificity was 95.42% (95% CI: 90.30-98.30). The area under the curve (AUC) was ≥0.97 for all three phase sectors in hemorrhages and ≥0.93 for the caudal and halo regions in calcifications.</p><p><strong>Conclusions: </strong>Phase signals of SWI, analyzed across both poles and the central halo, can successfully distinguish most intracranial hemorrhages and calcifications, regardless of their size, shape, or location.</p><p><strong>Abbreviations: </strong>AUC = Area Under the Curve; COVT = Cortical Vein Thrombosis; SSS = Superior Sagittal Sinus; AG = Arachnoid Granulation; SDH = Subdural Hemorrhage; IVH = Intraventricular Hemorrhage QSM = Quantitative Susceptibility Mapping; PPV = Positive Predictive Value; NPV = Negative Predictive Value.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145082670","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 Evaluation of Quantitative MRA for Cerebral Amyloid Angiopathy with Vascular Risk Factors.","authors":"Mohamad H Mosi, Dan Cheng, Mona Kharaji, Gador Canton, Charles Watt, Ahmed A Safwat, Kaiyu Zhang, Cristina Sanchez-Vizcaino, David Tirschwell, Niranjan Balu, Mahmud Mossa-Basha","doi":"10.3174/ajnr.A9007","DOIUrl":"https://doi.org/10.3174/ajnr.A9007","url":null,"abstract":"<p><strong>Background and purpose: </strong>Cerebral amyloid angiopathy (CAA) is a leading cause of intracranial hemorrhage and cognitive decline in the elderly. This study seeks to investigate the quantitative MRA features as new markers of CAA.</p><p><strong>Materials and methods: </strong>In this cross-sectional study, consecutive patients with CAA, along with controls, who underwent 3DTime-of-flight-MRA were included. Demographic and clinical data, including sex, age, diabetes, smoking, hypertension, and atrial fibrillation, were collected. Radiologic features, including the microhemorrhage classification, siderosis, and Fazekas scale, were also collected. Using in-house developed semi-automated software (VesselVoyager), quantitative MRA features, including total arterial length, number of branches, and tortuosity, were extracted. Univariable and multivariable logistic regression analyses were then performed to compare the CAA and non-CAA cohorts.</p><p><strong>Results: </strong>Seventy-four patients were included: 43 with CAA and 31 controls. Quantitative MRA analysis showed that patients with CAA had significantly reduced total arterial length (1900±1240 mm vs. 2880±1540 mm, p=0.006). Univariable logistic regression identified total arterial length (p=0.009), age (p=0.012), and total branch number (p=0.107) as relevant predictors of CAA. In multivariable analysis, total arterial length (OR = 0.95; 95% CI: 0.92-0.99; p=0.014) and age (1.06; 1.01-1.12; p=0.023) remained independently associated with CAA diagnosis.</p><p><strong>Conclusions: </strong>Quantitative MRA total arterial length is inversely independently and significantly associated with CAA diagnosis. This could potentially serve as an imaging marker of CAA diagnosis and potentially further elucidate vascular segment involvement in CAA patients.</p><p><strong>Abbreviations: </strong>CAA = Cerebral amyloid angiopathy; TOF-MRA = Time-of-flight MRA; LDL = Low-density lipoprotein; BMI = Body mass index.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145082714","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":"Head-to-Head Comparison of Two AI Computer-Aided Triage Solutions for Detecting Intracranial Hemorrhage on Non-Contrast Head CT.","authors":"Glenn M Garcia, Peter Young, Lydia Dawood, Mohammed Elshikh","doi":"10.3174/ajnr.A8986","DOIUrl":"https://doi.org/10.3174/ajnr.A8986","url":null,"abstract":"<p><strong>Background and purpose: </strong>This study aims to provide a comprehensive comparison of the performance and reproducibility of two commercially available artificial intelligence (AI) software computer-aided triage and notification solutions, Vendor A (Aidoc) and Vendor B (Viz.ai), for the detection of intracranial hemorrhage (ICH) on non-contrast enhanced head CT (NCHCT) scans performed within a single academic institution.</p><p><strong>Materials and methods: </strong>The retrospective analysis was conducted on a large patient cohort from multiple healthcare settings within a single academic institution, utilizing standardized scanning protocols. Sensitivity, specificity, false positive, and false negative rates were evaluated for both vendors. Outputs assessed included AI-generated case-level classification.</p><p><strong>Results: </strong>Among 4,081 scans, 595 were positive for ICH. Vendor A demonstrated a sensitivity of 94.4% and specificity of 97.4%, PPV of 85.9%, and NPV of 99.1%. Vendor B showed a sensitivity of 59.5% and specificity of 99.0%, PPV of 90.0%, and NPV of 92.6%. Vendor A had 20 false negatives, which primarily involved subdural and intraparenchymal hemorrhages, and 97 false positives, which appear to be related to motion artifact. Vendor B had 145 false negatives, largely comprised of subdural and subarachnoid hemorrhages, and 36 false positives, which appeared to be related to motion artifact and calcified or dense lesions. Concordantly, 18 cases were false negatives and 11 cases were false positives for both AI solutions.</p><p><strong>Conclusions: </strong>The findings of this study provide valuable information for clinicians and healthcare institutions considering the implementation of AI software for computer aided-triage and notification in the detection of intracranial hemorrhage. The discussion encompasses the implications of the results, the importance of evaluating AI findings in context-especially in the absence of explainability tools, potential areas for improvement, and the relevance of standardized scanning protocols in ensuring the reliability of AI-based diagnostic tools in clinical practice.</p><p><strong>Abbreviations: </strong>ICH = Intracranial Hemorrhage; NCHCT = Non-contrast Enhanced Head CT; AI = Artificial Intelligence; SDH = Subdural Hemorrhage; SAH = Subarachnoid Hemorrhage; IPH = Intraparenchymal Hemorrhage; IVH = Intraventricular Hemorrhage; PPV = Positive Predictive Value; NPV = Negative Predictive Value; CADt = Computer-Aided Triage; PACS = Picture Archiving and Communication System; FN = False Negative; FP = False Positive; CI = Confidence Interval.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145076920","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":"Imaging Differentiation of Supratentorial Ependymoma and High-grade Glioma in Children using VASARI Features.","authors":"Carmen R Cerron-Vela, Fabrício Guimarães Gonçalves, Luis Octavio Tierradentro-García, Angela N Viaene, Aashim Bhatia, Arastoo Vossough","doi":"10.3174/ajnr.A9001","DOIUrl":"https://doi.org/10.3174/ajnr.A9001","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background and purpose: &lt;/strong&gt;Supratentorial ependymomas (sEPN) and supratentorial high-grade gliomas (sHGG) are rare pediatric tumors with overlapping imaging features, making preoperative differentiation challenging. Accurate distinction is crucial for determining the appropriate management, guiding surgical decisions. The Visually Accessible Rembrandt Images (VASARI) feature set is a standardized MRI-based system for describing imaging characteristics of gliomas. VASARI has proven accessible, reproducible, and clinically helpful in characterizing tumor morphology. We hypothesize that a combination of imaging features can distinguish between these two tumor types. We evaluated a pediatric cohort with sEPN and sHGG to identify distinguishing imaging features, considering demographic and imaging factors. This approach aims to enhance diagnostic accuracy and improve individualized treatment planning.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Materials and methods: &lt;/strong&gt;This retrospective study enrolled patients &lt; 21 years old, with a histologically or molecularly confirmed sEPN or sHGG between 2000 and 2023. We evaluated 36 imaging features (54 including subcategories), incorporating VASARI set and additional tumor characterization parameters. Univariate analysis assessed relationships between demographic and imaging features and tumor type, followed by multivariate logistic regression. Finally, generalized binomial regression with regularization and variable selection was used to construct simplified parsimonious models of key distinguishing features for clinical use.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;45 patients were included, 26 sEPNs and 19 sHGGs. Sex distribution was similar between groups (61.5% female in sEPN and 78.9% in sHGG, p=0.18). By univariable analysis 16 imaging features differed significantly between tumors (p&lt;0.05), including proportion of enhancing/non-enhancing components, calcifications, T1WI/FLAIR ratio, T2WI signal, calvarial remodeling, and involvement of specific brain regions. Multivariate analysis incorporating these features achieved 100% accuracy in differentiating the tumors (AUC=1). A smaller parsimonious model that combined presence of calcifications and non-enhancing margin definition, accurately distinguished the tumors (AUC=0.98). Alternatively, using enhancing and non-enhancing margin definitions also achieved high accuracy (AUC=0.95).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Although sEPN and sHGG share overlapping imaging characteristics, a combination of 16 routine MRI features can fully differentiate them. Smaller subsets of two features (calcifications with definition of non-enhancing margins or the definitions of both enhancing and non-enhancing margins), also provide high diagnostic accuracy. These feature combinations improve differentiation and may support more informed treatment decisions, potentially leading to better patient outcomes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Abbreviations: &lt;/strong&gt;sEPN = Supratentorial ependymomas; sHGG = sup","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145076933","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}