AJNR. American journal of neuroradiology最新文献

{"title":"Shunting Arterio-Venous Lesions of The Cervical Spine: Diagnosis Across Imaging Modalities.","authors":"Masis Isikbay, Michael Travis Caton, Raghav Mattay, Sartaaj Walia, Daniel Cooke, Daniel Raper, Ethan Winkler, Luis Savastano, Kazim Narsinh, Steven Hetts, Matthew Amans","doi":"10.3174/ajnr.A9670","DOIUrl":"https://doi.org/10.3174/ajnr.A9670","url":null,"abstract":"<p><strong>Background: </strong>Shunting arteriovenous lesions of the central nervous system historically have been challenging to diagnose on non-invasive imaging given their subtle findings and complex anatomy. For this reason, catheter directed angiography has remained the gold standard for diagnosing and characterizing these lesions. While this should always remain a core component of working up suspected vascular lesions, other imaging modalities can be useful for making the diagnosis.</p><p><strong>Methods: </strong>We identified patients with shunting arteriovenous lesions of the cervical spine at our institution between the 1998-2023 and created a cohort of distinct vascular lesions. The imaging workup of each patient was reviewed to identify any diagnostic imaging modality which could detect a possible related abnormal finding. The associated medical record (including demographic data) was reviewed. Additionally, each patient's catheter directed angiography was evaluated to classify shunt location and presence of high-risk venous drainage.</p><p><strong>Results: </strong>52 arteriovenous shunting lesions of the cervical spine were identified. In certain cases non-invasive diagnostic imaging modalities identified an abnormality prior to catheter directed angiography (32/52, 62%). The most common modality to identify a relevant finding was MRI/MRA, (22 out of 39 patients who received an MRI revealed a relevant finding, 79%) with the most frequent finding being a discrete vascular lesion seen on MRI/MRA (11/22 positive cases, 50%). Notably a large portion of patients had no evidence of a vascular lesion prior to obtaining catheter directed angiography (20/52, 38%).</p><p><strong>Conclusion: </strong>While catheter directed angiography remains the best method of diagnosing and characterizing shunting vascular lesions of the spine, a large proportion of patients have imaging findings on non-invasive diagnostic imaging that suggest the presence of a vascular lesion. Identification of these imaging \"clues\", and subsequent referral to angiography, are essential to appropriate patient care given that many of these lesions have high risk features which can result in morbid complications.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149120030","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":"Cognitive Outcomes After Carotid Artery Stenting Versus Carotid Endarterectomy in Patients With Asymptomatic Carotid Stenosis: A Propensity Score-Matched Cohort Study.","authors":"Sabha Ahmed, Jay Kakadiya, Vidhi Dhaduk, Ankit Arora, Huanwen Chen, Matthew K McIntyre, Muhammed Amir Essibayi, Tobias D Faizy, Vivek S Yedavalli, Marco Colasurdo, Ajay Malhotra, Dheeraj Gandhi, Dhairya A Lakhani","doi":"10.3174/ajnr.A9666","DOIUrl":"https://doi.org/10.3174/ajnr.A9666","url":null,"abstract":"<p><strong>Background and objectives: </strong>Carotid artery stenting (CAS) and carotid endarterectomy (CEA) are established carotid revascularization options, but their long-term cognitive outcomes have not been compared directly at scale. We compared new-onset cognitive decline and dementia outcomes after CAS versus CEA for asymptomatic carotid stenosis.</p><p><strong>Methods: </strong>Using the TriNetX US Collaborative Network, we identified adults undergoing CAS or CEA for asymptomatic carotid stenosis (no prior infarct) without dementia or cognitive impairment at the time of procedure. Cohorts were balanced by 1:1 propensity-score matching on demographics, vascular and neuropsychiatric comorbidities, and antithrombotic medications. The prespecified primary endpoint was a composite of cognitive decline or dementia; cognitive decline and dementia were assessed individually as secondary endpoints. The outcomes were defined using ICD codes and assessed over 1, 3, and 5 years following intervention. A sensitivity analysis was additionally performed, excluding any lifetime cerebral infarction.</p><p><strong>Results: </strong>The primary analysis yielded 4,822 matched pairs; a sensitivity cohort additionally excluding lifetime cerebral infarction yielded 3,680 pairs. In the primary cohort, CAS was associated with higher 5-year event probabilities than CEA across all three endpoints (cognitive decline 16.68% vs 13.80%, HR 1.29, 1.13-1.48; dementia 5.02% vs 4.13%, HR 1.36, 1.04-1.76; composite 18.06% vs 15.24%, HR 1.29, 1.13-1.46). In the infarct-free sensitivity cohort, the composite and cognitive-decline associations were null at 5 years (composite HR 1.06; cognitive decline HR 0.99), while dementia remained modestly elevated (HR 1.38, 1.01-1.88; p=0.04).</p><p><strong>Conclusion: </strong>In patients treated for asymptomatic carotid stenosis, CAS was associated with higher rates of incident cognitive decline and dementia than CEA. After excluding patients with lifetime cerebral infarction, the composite and cognitive-decline associations were no longer present, and only a borderline dementia signal remained (HR 1.38, 95% CI 1.01-1.88; p=0.04). This pattern could reflect antecedent infarct burden, contributing to more cognitive symptoms in CAS group. However, further prospective studies are needed to confirm this finding.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149120052","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":"Spatial Distribution of Perivascular Spaces on MRI Is Associated with Disease Severity in Idiopathic Intracranial Hypertension.","authors":"Rafael Buongermini, Marko Tien, Jim Xie, Yash Patel, Jürgen Germann, Shivaprakash Hiremath, Emma Blanchette, Benjamin Morgan, Richard Zou, Hezekiah C T Au, Christine M Glastonbury, Edward Margolin, Alexandre Boutet","doi":"10.3174/ajnr.A9662","DOIUrl":"https://doi.org/10.3174/ajnr.A9662","url":null,"abstract":"<p><strong>Background and purpose: </strong>Glymphatic dysfunction, affecting cerebrospinal fluid transport and clearance, is increasingly implicated in idiopathic intracranial hypertension (IIH). Because perivascular spaces (PVS) reflect glymphatic activity, we evaluated whether their volume and spatial distribution could serve as imaging markers of IIH severity.</p><p><strong>Materials and methods: </strong>In this case-control study, 47 patients with IIH (mean age at MRI 32.5 ± 9.7 years; 44 women) and 47 epilepsy controls underwent non-contrast MRI with 3D FLAIR. PVS were manually segmented, volumetrically quantified, and normalized to standard space. Group-level frequency maps identified common PVS locations. Outcome-weighted maps (continuous and binary) assessed associations with ophthalmological severity, defined by visual field mean deviation (VFMD), peripapillary retinal nerve fiber layer thickness (pRNFL), and visual loss (best-corrected visual acuity <20/20). Odds ratio maps compared spatial distributions between groups. All maps were tested by permutation (one-tailed, p < 0.05). PVS volumes were compared using the Mann-Whitney U test, and multivariable linear regression assessed clinical associations.</p><p><strong>Results: </strong>Whole-brain PVS volume was higher in IIH than in controls (median 146.9 mm³ [IQR 95.4-206.2] vs. 105.3 mm³ [IQR 79.5-149.1]; p = 0.015), but was not associated with ophthalmological severity in adjusted models (all p > 0.05). On voxel-wise mapping, patients with more severe disease showed PVS preferentially in the amygdala, posterior internal capsules, and superior basal ganglia, with voxels significant on permutation testing within these regions for all three severity measures (p < 0.05). These regions were at least three times more likely to show PVS in IIH than in controls.</p><p><strong>Conclusions: </strong>While total PVS volume is increased in IIH, it was not associated with disease severity. Descriptive mapping suggests a distinct regional distribution of PVS in more severe disease particularly in the amygdala, posterior internal capsules, and basal ganglia. Validation in larger cohorts is required before this distribution can be adopted as a severity marker.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149120054","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":"Third Ventricular Volume as an Adjunct Imaging Marker for CSF-Venous Fistulas Causing Spontaneous Intracranial Hypotension.","authors":"Sevda Alipour Khabir, David F Black, Daniel J Blezek, Steven A Messina, Ola Mohamed, Lalani Carlton Jones, John P Welby, Ian T Mark","doi":"10.3174/ajnr.A9665","DOIUrl":"https://doi.org/10.3174/ajnr.A9665","url":null,"abstract":"<p><strong>Background: </strong>CSF-venous fistulas (CVFs) are an increasingly recognized cause of spontaneous intracranial hypotension (SIH); however, brain MRI findings may be normal in approximately 20% of patients, underscoring the need for additional imaging markers. This study aimed to evaluate third ventricular volume as an adjunct imaging biomarker for patients with CVF causing SIH, particularly in patients with low-risk conventional MRI findings.</p><p><strong>Methods: </strong>A total of 32 patients with myelographically confirmed CVF who underwent pre-treatment brain MRI were included. Third ventricular volume and total ventricular CSF volume were measured and converted to age- and sex-adjusted normative percentiles (Combinostics, Tampere, Finland). Small third ventricular volume and low total ventricular CSF volume were defined as values below the 25th normative percentile. Findings were evaluated in the overall cohort and stratified by Bern score, with low-probability Bern score defined as 0-2.</p><p><strong>Results: </strong>The mean age was 55.7 years, and 21/32 patients were female. Mean third ventricular percentile was 21.9 ± 27.2 and mean total ventricular CSF percentile was 35.4 ± 23.7. In the overall cohort, 22/32 patients (68.8%) had small third ventricular volume, whereas 10/32 patients (31.3%) had low total ventricular CSF volume. Among patients with Bern scores of 0-2, 5/10 patients (50.0%) had small third ventricular volume, compared with 1/10 patients (10.0%) with low total ventricular CSF volume. Third ventricular percentile showed a weak to moderate positive correlation with total ventricular CSF percentile (ρ = 0.45, p = 0.0097); however, among the 22 patients with small third ventricular volume, 14 (63.6%) had preserved total ventricular CSF volume, representing 43.8% of the overall cohort (14/32). Exploratory symptom-based analyses did not identify statistically significant associations with small third ventricular volume.</p><p><strong>Conclusion: </strong>Reduced third ventricular volume was common in patients with CVF-related SIH and was more frequently observed than low total ventricular CSF volume, including among patients with low-probability Bern scores. Third ventricular volumetry may provide a useful adjunct imaging marker for CVF-related SIH, particularly when brain MRI findings are nondiagnostic.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149120063","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":"Comparison of Diffusion-Weighted Magnetic Resonance Imaging of the Fetal Brain in Pregnant Women with Gestational Diabetes Mellitus and in Normal Fetuses: A Matched Case-Control Study.","authors":"Guohui Yan, Yongqing Zhang, Weizeng Zheng, Shuqi Zhu, Kui Li, Qi Wu, Shiguang Li, Tiantian Fu, Yu Zou, Zhaoxia Liang","doi":"10.3174/ajnr.A9663","DOIUrl":"https://doi.org/10.3174/ajnr.A9663","url":null,"abstract":"<p><strong>Objectives: </strong>Comparison of fetal neurodevelopmental indicators between women with gestational diabetes mellitus and those without gestational diabetes mellitus using brain DWI.</p><p><strong>Methods: </strong>A total of 146 pregnant women with gestational diabetes mellitus and 146 normal pregnant women matched 1:1 by maternal age and gestational age (26-40 weeks) were included in the study. Parametric analyses were performed using the t-test, while non-parametric analyses were conducted with the Mann-Whitney U test to compare differences between the gestational diabetes mellitus and control groups. Categorical variables were analyzed using the chi-square test. Subsequently, linear regression analysis was applied to evaluate the association between ADC values and fetal gestational age.</p><p><strong>Results: </strong>Fetuses in the gestational diabetes mellitus group exhibited significantly higher average ADC values in the MBH, BG, THAL, and pons compared to those in the control group (<i>p</i> < 0.05). In contrast, regions with significantly lower ADC values in the fetal brain included the CSO, PWM, and OWM (<i>p</i> < 0.05).</p><p><strong>Conclusions: </strong>The differences in ADC values between the gestational diabetes mellitus and normal fetal groups in intracranial regions, including the MBH, BG, THAL, pons, CSO, PWM, and OWM, were statistically significant, which may provide preliminary evidence that gestational diabetes mellitus exposure is associated with altered fetal brain microstructure, as indicated by region-specific reductions in ADC values.</p><p><strong>Critical relevance statement: </strong>This exploratory, preliminary case-control study shows region-specific fetal brain ADC changes on DWI associated with gestational diabetes mellitus exposure, offering early in utero imaging clues to microstructural alterations that may inform future neurodevelopmental risk evaluation.</p><p><strong>Highlights: </strong>1 Neurodevelopmental differences between fetuses of pregnant women with gestational diabetes mellitus and in healthy pregnancies remain uncertain. 2 Significant differential changes in the development of different brain regions distributed across gestational weeks in gestational diabetes mellitus exposed fetuses were noted compared to those in normal fetuses. 3 This exploratory study identifies gestational diabetes mellitus related fetal brain ADC alterations, offering preliminary in utero imaging evidence to advance prenatal neurodevelopmental radiological assessment.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149120047","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":"Prompt volumetric responses following preoperative embolization of skull base meningiomas: association with intratumoral contrast enhancement loss.","authors":"Hiroki Sakamoto, Takao Hashimoto, Ken Matsushima, Yusuke Arai, Kyosuke Matsunaga, Muneaki Kikuno, Michihiro Kohno","doi":"10.3174/ajnr.A9661","DOIUrl":"https://doi.org/10.3174/ajnr.A9661","url":null,"abstract":"<p><strong>Objective: </strong>The role of preoperative embolization for skull base meningiomas remains controversial because potential surgical benefits must be balanced against endovascular procedural risks. Although embolization may induce early tumor volume reduction, evidence in skull base meningiomas remains limited. This study evaluated prompt volumetric responses after preoperative embolization and their association with intratumoral contrast enhancement loss on magnetic resonance imaging (MRI).</p><p><strong>Methods: </strong>This retrospective study included 82 consecutive patients with skull base meningiomas who underwent preoperative endovascular embolization followed by surgical resection at a single institution between September 2013 and March 2025. Tumor volumes were measured on contrast-enhanced T1-weighted MRI obtained pre- and post-embolization. Individual volumetric responses were evaluated, and patients were categorized into four groups according to the degree of intratumoral contrast enhancement loss. Neurological complications were assessed.</p><p><strong>Results: </strong>Tumor volume was significantly reduced after embolization (18.9 ± 14.2 mL vs 17.3 ± 13.7 mL, P < .001), with a mean reduction rate of 10.5 ± 12.4%, within a mean interval of 4.1 ± 1.8 days after embolization. Tumor volume decreased in 74 of 82 patients (90.2%). Volumetric responses exhibited substantial heterogeneity, ranging from -34.5% to 41.1%. Greater intratumoral contrast enhancement loss was associated with larger volume reduction rates (P = .04). Transient neurological complications occurred in 4 patients (4.9%), and permanent deficits occurred in 2 patients (2.4%).</p><p><strong>Conclusions: </strong>Preoperative embolization of skull base meningiomas was associated with early tumor volume reduction within days, although the magnitude of response varied substantially among tumors. Intratumoral contrast enhancement loss on post-embolization MRI was associated with greater tumor volume reduction and may serve as a semiquantitative imaging correlate of reduced tumor vascularity/perfusion after embolization.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149120040","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":"Whole-brain cortical morphometry and structural covariance network disruption in subacute sclerosing panencephalitis.","authors":"Anuran Mukherjee, Krishnendu Vyas, Apurva Shah, Jitender Saini, Ajay Asranna, Hansashree Padmanabha, K Raghavendra, Ravindranadh Chowdary Mundlamuri, Sanjib Sinha, Lakshminarayanapuram Gopal Viswanathan","doi":"10.3174/ajnr.A9660","DOIUrl":"https://doi.org/10.3174/ajnr.A9660","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Subacute sclerosing panencephalitis (SSPE) is a progressive, fatal encephalitis caused by persistent measles virus infection. Quantitative cortical imaging in SSPE remains poorly characterised, and the topology of the cortical structural covariance network (SCN) has not been examined.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To characterise whole-brain cortical structural alterations in SSPE using surface-based morphometry (SBM) and voxel-based morphometry (VBM), evaluate their clinical correlates, and describe the topology of the cortical SCN.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Twenty-eight patients with SSPE and 48 age- and sex-matched healthy controls underwent 3.0 T volumetric T1-weighted MRI. SBM was performed in FreeSurfer using the Desikan-Killiany (DK) atlas, adjusted for age and sex; VBM used the FSL-VBM pipeline with threshold-free cluster enhancement, adjusted for age, sex and total intracranial volume. Clinical associations used Pearson correlation with false discovery rate (FDR) correction and Spearman sensitivity analyses; severity was quantified with the Neurological Disability Index. Group-level SCNs were constructed from age- and sex-adjusted regional thickness correlations; graph metrics were computed across 16 network densities and summarised as the area under the metric-versus-density curve, so that findings do not depend on a single arbitrary threshold. Group differences were assessed by subject-label permutation testing with bootstrap confidence intervals.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;VBM identified widespread bilateral grey matter volume reduction extending from cortex into deep grey matter and cerebellum, with additional right-lateralised clusters in the planum temporale and frontal pole. Vertex-wise SBM demonstrated 35 bilateral cortical thickness clusters and 21 cortical volume clusters; in the covariate-adjusted regional analysis, 38 of 68 DK regions showed significant thinning after FDR correction, and 18 of 68 regions showed significant volume reduction, most prominently the bilateral frontal pole and posterior cortices. Cortical thickness and volume correlated negatively with disease duration across most regions, but not with clinical severity. SCN metrics differed consistently in direction across all densities - longer characteristic path length, higher modularity and local efficiency, and loss of degree assortativity in patients - but no metric difference survived subject-label permutation testing after FDR correction (smallest adjusted p = 0.24); SCN findings are therefore reported as descriptive.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;SSPE produces widespread, duration-dependent cortical thinning and grey matter volume loss involving association, limbic and primary cortices. Group-level SCN topology showed a consistent directional pattern of network reorganisation that did not reach corrected statistical significance at this sample size. Prospective, longitudinal and multi-centre studies are","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149120056","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 Noncontrast CT Imaging Markers Enhance Posttransfer DWI Core Volume Prediction.","authors":"Henk van Voorst, Praneeta Konduri, Adrien Ter Schiphorst, Lieselotte Vandewalle, Yongkai Liu, Bin Jiang, Ewout Heylen, Michael Mlynash, Soren Christensen, Seena Dehkharghani, Gregory W Albers, Greg Zaharchuk, Maarten G Lansberg, Jeremy J Heit","doi":"10.3174/ajnr.A9311","DOIUrl":"10.3174/ajnr.A9311","url":null,"abstract":"<p><strong>Background and purpose: </strong>Deep learning enables the extraction of ischemic lesion size and hypodensity imaging markers from deep learning-based NCCT (DLNCCT) assessment in patients with acute ischemic stroke, but it remains unclear whether those markers can predict posttransfer core volume.</p><p><strong>Materials and methods: </strong>We performed a post hoc analysis of prospectively enrolled patients transferred from a primary stroke center (PSC) to a comprehensive stroke center (CSC) for endovascular treatment (EVT). Using a validated DLNCCT segmentation method, we quantified total lesion volume (per 10 mL), modified net water uptake (mNWU %), and severely hypodense volume (≤26 Hounsfield units [HU] per 10 mL) and compared these markers with core lab rated ASPECTS (per point decrease) and CTP-based evaluation for their association with (adjusted regression coefficient [95% CI]) and predictive performance in addition to baseline variables (<i>R</i> ² ± SEs) for posttransfer CSC admission DWI core volume.</p><p><strong>Results: </strong>We included 420 patients (239 [57%] men) with a median age of 72 years (interquartile range: 61-80). We observed 11.2 mL (95% CI, 8.3-14.1] larger posttransfer core volumes per point decrease in ASPECTS, and 10.0 mL (95% CI, 6.8-13.3), and 20.0 mL (95% CI, 12.7-27.2) larger posttransfer core volumes per 10-mL increase in total and severely hypodense DLNCCT volume, respectively. mNWU was not associated with posttransfer core volume (<i>P</i> = .63). In addition to clinical baseline and CTA variables, posttransfer core volume prediction with ASPECTS (<i>R</i> ²: 0.49 ± 0.02) and DLNCCT (<i>R</i> ²: 0.50 ± 0.02) did not differ significantly (<i>P</i> = .58). Compared with using CTP imaging markers (<i>R</i> ²: 0.56 ± 0.02), adding ASPECTS (<i>R</i> ²: 0.63 ± 0.02; <i>P</i> < .01) and DLNCCT (<i>R</i> ²: 0.65 ± 0.01; <i>P</i> < .01) improved performance for posttransfer core volume prediction.</p><p><strong>Conclusions: </strong>Total and severely hypodense DLNCCT volumes are independent predictors for posttransfer core volume. These DLNCCT markers improved CTP-based posttransfer core volume prediction.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":"2589-2595"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13629730/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147596962","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Susceptibility-Weighted Imaging in Patients with Corticobasal Syndrome or Progressive Supranuclear Palsy: Distribution of Iron Deposits Reflects Clinical Symptoms in 4-Repeat Tauopathies.","authors":"Gianmichele Migaleddu, Eleonora Del Prete, Graziella Donatelli, Daniela Frosini, Roberto Ceravolo, Mirco Cosottini","doi":"10.3174/ajnr.A9338","DOIUrl":"10.3174/ajnr.A9338","url":null,"abstract":"<p><strong>Background and purpose: </strong>Patients with corticobasal syndrome (CBS) and progressive supranuclear palsy (PSP) often show the loss of the swallow tail sign, which reflects degeneration of dopaminergic neurons and iron accumulation in the substantia nigra pars compacta, and peculiar neuroradiologic signs that are, respectively, asymmetrical frontoparietal atrophy and midbrain atrophy. A T2* hypointense rim likely reflecting presence and distribution of neuroinflammation has been recently reported in the frontal cortex of patients with CBS. Here we investigated: 1) the frequency of conventional radiologic signs associated with CBS and PSP and 2) presence, distribution, and frequency of the T2* signal hypointensity in the frontal cortex in patients with CBS and PSP. In addition, we explored possible associations between T2* hypointensity in the frontal cortex and clinical symptoms.</p><p><strong>Materials and methods: </strong>Sixty-two patients were retrospectively included in the study (14 CBS and 48 PSP). Two neuroradiologists inspected the 3T MR data sets and recorded the presence/absence of: asymmetric frontoparietal atrophy, midbrain atrophy, loss of the swallow tail sign, and T2* hypointensity of the frontal cortex.</p><p><strong>Results: </strong>Asymmetrical frontoparietal atrophy and T2* hypointensity in the frontal cortex were more frequent in patients with CBS (<i>P</i> < .001), whereas midbrain atrophy and the loss of the swallow tail sign were more frequent in patients with PSP (<i>P</i> < .001). The T2* signal hypointensity in the frontal cortex was detected in 14 patients with CBS (100%) and 5 patients with PSP (10%) and had 3 possible patterns of distribution associated with specific symptoms: 1) involvement of the hand knob only (3 patients with CBS and none with PSP) in patients with unilateral ideomotor apraxia; 2) involvement of the primary motor cortex that extended beyond the hand knob (2 patients with CBS and 5 with PSP; both patients with CBS had bilateral ideomotor apraxia); and 3) involvement of the primary motor cortex, the superior frontal gyrus, and/or the middle frontal gyrus (9 patients with CBS and none with PSP); all but 1 of these patients had ideomotor limb apraxia and all had speech/language impairment.</p><p><strong>Conclusions: </strong>The T2* signal hypointensity in the frontal cortex may be an additional radiologic sign to be assessed in patients with atypical parkinsonism. Its distribution across the frontal gyri likely reflects clinical symptoms. The pathologic assessment of CBS cases would support the robustness of these results.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147640515","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":"Volumetric Postcontrast T1 Turbo Spin-Echo vs Gradient-Recalled Echo MR Sequences for Detecting Brain Metastases: A Systematic Review and Meta-Analysis.","authors":"Anass Benomar, Sukhmanjit S Ghumman, Youcef Ouahdi, Sherief Ghozy, Hany Soliman, Kang Liang Zeng, Chia-Lin Tseng, Jay Detsky, Hanbo Chen, Deepak Dinakaran, Qing Fu, Sean Symons, Arjun Sahgal, Chris Heyn, Pejman Jabehdar Maralani","doi":"10.3174/ajnr.A9294","DOIUrl":"10.3174/ajnr.A9294","url":null,"abstract":"<p><strong>Background: </strong>Contrast-enhanced 3D T1-weighted MRI is the imaging reference for detection and follow-up of brain metastases. Volumetric GRE-based sequences, such as MPRAGE, are widely used but remain prone to susceptibility and lower lesion conspicuity. 3D black-blood TSE-based sequences, such as sampling perfection with application-optimized contrasts by using different flip angle evolutions (SPACE), have been increasingly embedded into routine workflow and are thought to improve lesion detection in part through vessel signal suppression.</p><p><strong>Purpose: </strong>We aimed to investigate the comparative diagnostic performance of 3D T1 TSE vs GRE sequences for the detection of brain metastases.</p><p><strong>Data sources: </strong>Studies comparing the diagnostic performance of postcontrast 3D T1 TSE and GRE sequences in adults with brain metastases were searched on MEDLINE, EMBASE, Cochrane Central, Google Scholar, and PROSPERO, from inception through April 2025.</p><p><strong>Study selection: </strong>Fifteen studies encompassing 544 patients with 4338 metastases were included.</p><p><strong>Data analysis: </strong>Data on diagnostic accuracy parameters, image quality, and interrater agreement were extracted. Random-effects models were applied to compute pooled sensitivity and comparative OR for lesion detection. Risk of bias was assessed using QUADAS-2 and QUADAS-C tools.</p><p><strong>Data synthesis: </strong>Pooled sensitivities for detection of brain metastases were 97.4% (95% CI, 93.2%-99.0%) for TSE- and 76.1% (95% CI, 69.3-81.9) for GRE-based sequences, with a comparative OR of 12.0 (95% CI, 5.45-26.6; <i>P</i> < .0001). Detectability of small lesions (<5 mm) was significantly better on TSE (96.1%; 95% CI, 87.7-98.8) than GRE (58.4%; 95% CI, 47.9-68.2), although both techniques performed comparably for larger (≥5 mm) lesions (98.2% for TSE, 94.4% for GRE). OR estimates were 17.2 (95% CI, 4.50-66.1) for small and 2.81 (95% CI, 0.92-8.56) for large lesions. Contrast-to-noise ratio and interrater agreements were slightly higher on TSE than GRE. False-positives (FPs) were more common with TSE, mostly related to incomplete vessel suppression (49 FP counts in TSE, 35 in GRE).</p><p><strong>Limitations: </strong>Our meta-analysis is limited by high heterogeneity, case-only studies, possible small-study effects, and high risk of bias for the reference standard domain.</p><p><strong>Conclusions: </strong>Postcontrast 3D T1 TSE sequences provide higher sensitivity and improved lesion conspicuity compared with GRE sequences, particularly for small metastases, although at the cost of slightly higher FPs.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":"2572-2579"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13629716/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147446343","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}