AJNR. American journal of neuroradiology最新文献

{"title":"Hypoperfusion Intensity Ratio Less Than 0.4 Is Associated with Favorable Outcomes in Unsuccessfully Reperfused Acute Ischemic Stroke with Large-Vessel Occlusion.","authors":"Vivek Yedavalli, Hamza Adel Salim, Aneri Balar, Dhairya A Lakhani, Janet Mei, Hanzhang Lu, Licia Luna, Francis Deng, Vaibhav Vagal, Nathan Z Hyson, Jens Fiehler, Paul Stracke, Gabriel Broocks, Christian Heitkamp, Gregory W Albers, Max Wintermark, Tobias D Faizy, Jeremy J Heit","doi":"10.3174/ajnr.A8518","DOIUrl":"10.3174/ajnr.A8518","url":null,"abstract":"<p><strong>Background and purpose: </strong>Endovascular thrombectomy is a standard treatment for acute ischemic stroke due to large-vessel occlusions (AIS-LVO), but a large minority of patients do not achieve successful reperfusion. This study aimed to investigate the hypoperfusion intensity ratio (HIR) as a prognostic biomarker in unsuccessfully reperfused patients with AIS-LVO.</p><p><strong>Materials and methods: </strong>A multicenter retrospective cohort study was conducted at 2 comprehensive stroke centers, involving patients with AIS-LVO who underwent endovascular thrombectomy but did not achieve successful reperfusion, defined as a modified TICI score of 0-2a. HIR, derived from CT or MR perfusion imaging, was analyzed for its association with favorable clinical outcomes (90-day mRs score of 0-2). The optimal HIR threshold predictive of favorable outcomes was identified through receiver operating curve analysis.</p><p><strong>Results: </strong>Of 129 patients included, 20 (15.5%) achieved favorable outcomes. HIR of <0.4 significantly predicted favorable outcomes with a sensitivity of 66% and specificity of 80%. Patients with an HIR of <0.4 demonstrated better clinical and imaging profiles, including lower admission NIHSS scores and smaller ischemic core volumes. Multivariable logistic regression confirmed HIR, along with age and the presence of hemorrhagic transformation, as independent predictors of favorable outcomes.</p><p><strong>Conclusions: </strong>In unsuccessfully reperfused patients with AIS-LVO, an HIR of <0.4 is associated with favorable outcomes, emphasizing on the importance of robust collateral circulation. This finding suggests that perfusion imaging and HIR evaluation could guide clinical decision-making and prognostication in this challenging patient subset.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":"483-488"},"PeriodicalIF":0.0,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143469917","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 Changes of the Choroid Plexus before and after Spinal CSF Leak Repair.","authors":"Karen Buch, Aaron Paul, Neo Poyiadji, William A Mehan","doi":"10.3174/ajnr.A8514","DOIUrl":"10.3174/ajnr.A8514","url":null,"abstract":"<p><strong>Background and purpose: </strong>Patients with intracranial hypotension from spinal CSF leaks have increased choroid plexus volumes in response to CSF leakage. The purpose of this study was to assess changes in choroid plexus volumes in patients before and after spinal CSF leak repair.</p><p><strong>Materials and methods: </strong>This was a retrospective, institutional review board-approved study on patients with spinal CSF leak who had pre- and post-CSF leak repair MRI examinations. Brain MRIs with contrast were performed on a 1.5/3T scanner with acquisition of 3D T1 postcontrast (eg, Bravo, MPRAGE, and so forth). Choroid plexus volumes at the level of the trigonum ventriculi were calculated for the left and right sides on all pre- and posttreatment MRIs using Visage-7 segmentation tools. Basic demographic data, type of CSF leak, and choroid plexus volumes were recorded for all patients. Basic 2-tailed <i>t</i> tests were used to compare choroid plexus volumes between the pre- and posttreatment groups.</p><p><strong>Results: </strong>Twenty patients with spontaneous intracranial hypotension from spinal CSF leaks were included. Eleven patients (55%) had a type 1a (ventral tear) spinal CSF leak, 5 patients (25%) had type 1b (lateral tear), and 4 patients (20%) had a type 3 spinal CSF leak. The mean age was 47.6 years (SD, 13.8 years). The mean choroid plexus volumes pretreatment were 0.82 cm³ (SD, 0.29 cm³) compared with 0.38 cm³ (SD, 0.19 cm³) posttreatment (<i>P</i> value 0.01).</p><p><strong>Conclusions: </strong>Significantly decreased choroid plexus volumes were seen in patients with spontaneous intracranial hypotension following spinal CSF leak repair. This finding highlights the modulation and dynamic role of the choroid plexus in states of low CSF volumes.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":"598-601"},"PeriodicalIF":0.0,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143469922","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":"Assessment of Trigeminal Nerve Root Demyelination in Patients with Primary Trigeminal Neuralgia Using Macromolecular Proton Fraction Imaging.","authors":"Elena A Filimonova, Anton A Pashkov, Vasily L Yarnykh, Maria I Schukina, Boris A Zaitsev, Azniv V Martirosyan, Galina I Moysak, Jamil A Rzaev","doi":"10.3174/ajnr.A8545","DOIUrl":"10.3174/ajnr.A8545","url":null,"abstract":"<p><strong>Background and purpose: </strong>Primary trigeminal neuralgia (PTN) is a prevalent chronic pain disorder. This condition is believed to be associated with demyelination of the trigeminal nerve. Previous studies in this field have focused on diffusion tensor imaging, which has limited sensitivity and specificity to myelin. In the present study, we assessed the trigeminal nerve root via the macromolecular proton fraction (MPF) mapping technique. MPF demonstrated strong correlations with myelin histology in a number of earlier animal studies and is currently viewed as a promising clinical myelin biomarker.</p><p><strong>Materials and methods: </strong>We performed a prospective case-control study. Fifty-six patients with unilateral PTN and 27 healthy controls were included. All participants were evaluated by using high-resolution brain MR imaging, which included the MPF technique. MPF values from different parts of the trigeminal nerve root, such as the root entry zone (REZ) and central and lateral cisternal segments, were extracted. ANCOVAs were performed. Correlations between MPF values and Sindou grade, duration, and intensity of symptoms were also evaluated in patients with PTN.</p><p><strong>Results: </strong>A statistically significant decrease in the average MPF of the affected trigeminal nerve root was observed in the PTN group compared with the healthy control group (<i>P</i> < .01, false discovery rate [FDR] corrected). Specifically, reductions in the MPF values of the REZ and central cisternal parts of the affected trigeminal nerve root were found in patients with PTN (<i>P</i> < .01 and <i>P</i> < .05, respectively, FDR corrected). Furthermore, we identified a decrease in the average and REZ MPF values on the affected side compared with the contralateral side in patients with PTN (<i>P</i> < .05 and <i>P</i> < .001, respectively, FDR corrected). A negative correlation between MPF values in the REZ and Sindou grade was revealed (<i>R</i> = -0.35, adjusted <i>P</i> < .05).</p><p><strong>Conclusions: </strong>Our preliminary results suggest that MPF could serve as a new neuroimaging biomarker of trigeminal nerve root impairment in patients with PTN and enable noninvasive detection of nerve root demyelination.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":"602-610"},"PeriodicalIF":0.0,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143525460","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":"Performance of Automated Algorithm in Large and Medium Vessel Occlusion Detection: A Real-World Experience.","authors":"Aakanksha Sriwastwa, Yasmin N Aziz, Kara Weiss, Robert Buse, Bin Zhang, Stacie L Demel, Arafat Ali, Sriharsha Voleti, Lily Li-Li Wang, Achala S Vagal","doi":"10.3174/ajnr.A8509","DOIUrl":"10.3174/ajnr.A8509","url":null,"abstract":"<p><strong>Background and purpose: </strong>Fast, accurate detection of large (LVO) and medium vessel occlusion (MeVO) is critical for triage and management of acute ischemic stroke. Multiple artificial intelligence (AI)-based software programs are available commercially for automated detection and rapid prioritization of LVO. However, their ability, strengths, and limitations for detection of acute vessel occlusion in the context of expanding indications for mechanical thrombectomy are not entirely understood. We aimed to investigate the performance of a fully automated commercial detection algorithm to detect large and medium vessel occlusions in code stroke patients.</p><p><strong>Materials and methods: </strong>We utilized a single-center, institutional, retrospective registry of all consecutive code stroke patients with CTA and automated processing by using Viz.ai presenting at a large comprehensive stroke center between March 2020 and February 2023. LVO was categorized as anterior LVO (aLVO), defined as occlusion of the intracranial ICA or M1-MCA, and posterior LVO (pLVO), defined as occlusion of the basilar artery or V4-vertebral artery. MeVO was defined as occlusion of the M2-MCA, A1/A2-anterior cerebral artery, or P1/P2-posterior cerebral artery. We compared the accuracy of Viz.ai by using STARD guidelines. Radiology reports from 12 board-certified radiologists were considered the reference standard. Our primary outcome was assessing accuracy of the automated software for aLVO. Our secondary outcome was assessing accuracy for 3 additional categories: all LVO (aLVO and pLVO), aLVO with M2-MCA, and aLVO with MeVO.</p><p><strong>Results: </strong>Of 3590 code stroke patients, 3576 were technically sufficient for analysis by the automated software (median age 67 years; 51% women; 68% white), of which 616 (17.2%) had vessel occlusions. The respective sensitivity and specificity for our prespecified categories were: aLVO: 91% (87-94%), 93% (92-94%); all LVO: 73% (68-77%), 92% (91-93%); aLVO + M2-MCA occlusion: 74% (70-78%), 93% (92-94%); and aLVO + all MeVO: 65% (61-69%), 93% (92-94%).</p><p><strong>Conclusions: </strong>The automated algorithm demonstrated high accuracy in identifying anterior LVO with lower performance for pLVO and MeVO. It is crucial for acute stroke teams to be aware of the discordance between automated algorithm results and true rates of LVO and MeVO for timely diagnosis and triage.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":"476-482"},"PeriodicalIF":0.0,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142334164","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":"Multicenter Automated Central Vein Sign Detection Performs as Well as Manual Assessment for the Diagnosis of Multiple Sclerosis.","authors":"A R Manning, V Letchuman, M L Martin, E Gombos, T Robert-Fitzgerald, Q Cao, P Raza, C M O'Donnell, B Renner, L Daboul, P Rodrigues, M Ramos, J Derbyshire, C Azevedo, A Bar-Or, E Caverzasi, P A Calabresi, B A C Cree, L Freeman, R G Henry, E E Longbrake, J Oh, N Papinutto, D Pelletier, R D Samudralwar, S Suthiphosuwan, M K Schindler, M Bilello, J W Song, E S Sotirchos, N L Sicotte, O Al-Louzi, A J Solomon, D S Reich, D Ontaneda, P Sati, R T Shinohara","doi":"10.3174/ajnr.A8510","DOIUrl":"10.3174/ajnr.A8510","url":null,"abstract":"<p><strong>Background and purpose: </strong>The central vein sign (CVS) is a proposed diagnostic imaging biomarker for multiple sclerosis (MS). The proportion of white matter lesions exhibiting the CVS (CVS+) is higher in patients with MS compared with its radiologic mimics. Evaluation for CVS+ lesions in prior studies has been performed by manual rating, an approach that is time-consuming and has variable interrater reliability. Accurate automated methods would facilitate efficient assessment for CVS. The objective of this study was to compare the performance of an automated CVS detection method with manual rating for the diagnosis of MS.</p><p><strong>Materials and methods: </strong>3T MRI was acquired in 86 participants undergoing evaluation for MS in a 9-site multicenter study. Participants presented with either typical or atypical clinical syndromes for MS. An automated CVS detection method was employed and compared with manual rating, including total CVS+ proportion and a simplified counting method in which experts visually identified up to 6 CVS+ lesions by using FLAIR* contrast (a voxelwise product of T2 FLAIR and postcontrast T2*-EPI).</p><p><strong>Results: </strong>Automated CVS processing was completed in 79 of 86 participants (91%), of whom 28 (35%) fulfilled the 2017 McDonald criteria at the time of imaging. The area under the receiver operating characteristic curve (AUC) for discrimination between participants with and without MS for the automated CVS approach was 0.78 (95% CI: [0.67,0.88]). This was not significantly different from simplified manual counting methods (select6*) (0.80 [0.69,0.91]) or manual assessment of total CVS+ proportion (0.89 [0.82,0.96]). In a sensitivity analysis excluding 11 participants whose MRI exhibited motion artifact, the AUC for the automated method was 0.81 [0.70,0.91], which was not statistically different from that for select6* (0.79 [0.68,0.92]) or manual assessment of total CVS+ proportion (0.89 [0.81,0.97]).</p><p><strong>Conclusions: </strong>Automated CVS assessment was comparable to manual CVS scoring for differentiating patients with MS from those with other diagnoses. Large, prospective, multicenter studies utilizing automated methods and enrolling the breadth of disorders referred for suspicion of MS are needed to determine optimal approaches for clinical implementation of an automated CVS detection method.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":"620-626"},"PeriodicalIF":0.0,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142334163","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":"Patient and Provider Characteristics Associated with the Receipt of Image-Guided Interventions for Low Back Pain.","authors":"Ghazaleh Safazadeh, Ruth C Carlos, Lubdha M Shah, Gregory J Stoddard, Rebecca Steed, Troy A Hutchins, Miriam E Peckham","doi":"10.3174/ajnr.A8502","DOIUrl":"10.3174/ajnr.A8502","url":null,"abstract":"<p><strong>Background and purpose: </strong>Low back pain (LBP) commonly causes disability, often managed with conservative image-guided interventions before surgery. Research has documented racial disparities with these and other nonpharmacologic treatments. We posited that individual chart reviews may provide insight into the disparity of care types through documented patient/provider discussions and their effect on treatment plans.</p><p><strong>Materials and methods: </strong>This retrospective analysis involved adults newly diagnosed with LBP in a large Utah health care system. The primary outcome was the association of provider and patient variables with the frequency of image-guided interventions received within 1 year of LBP diagnosis between White/non-Hispanic and underrepresented minority cohorts. Secondary outcomes were receipt of additional treatment types (physical therapy and lumbar surgery), time to any treatment, time to image-guided intervention, and discussion/receipt of therapy between cohorts within 1 year of diagnosis.</p><p><strong>Results: </strong>Among 812 subjects (59% White/non-Hispanic and 41% underrepresented minority), more White/non-Hispanic patients had at least 1 image-guided intervention within 12 months compared with underrepresented minority patients (12.5% versus 7.2%, <i>P</i> = .01), despite underrepresented minorities having higher presenting pain scores (64.5% versus 49.3%; pain intensity, >5; <i>P</i> = .001). Underrepresented minority patients more often saw generalists (71.7% versus 52.6%, <i>P</i> < .001) and advanced practice clinician providers (33.6% versus 25.6%, <i>P</i> < .02) compared with the White/non-Hispanic cohort. Both cohorts were referred to a specialist at the same rate (17.7% versus 19.8%, <i>P</i> = .20); however, referral completion was noted less often (60.4% versus 77.7%, <i>P</i> = .02) and took longer to complete in underrepresented minority patients (mean, 54 versus 27.5 days; <i>P</i> = .003).</p><p><strong>Conclusions: </strong>Underrepresented minority patients had more severe LBP on presentation but received image-guided interventions less often than White/non-Hispanic patients. Our in-depth chart analysis supports the lack of referral completion and evaluation from a spine specialist provider as the main deterrent to the receipt of image-guided interventions in this cohort. While there may be systematic provider barriers such as an absence of decision-making discussion, data do not support provider bias as a contributing factor to differences in receipt of image-guided interventions.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":"589-596"},"PeriodicalIF":0.0,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142303161","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":"Diffusion- and Tractography-Based Characterization of Tissue Damage Within and Surrounding Paramagnetic Rim Lesions in Multiple Sclerosis.","authors":"Maryam Mohebbi, Jack A Reeves, Dejan Jakimovski, Alexander Bartnik, Niels Bergsland, Fahad Salman, Ferdinand Schweser, Bianca Weinstock-Guttman, Robert Zivadinov, Michael G Dwyer","doi":"10.3174/ajnr.A8524","DOIUrl":"https://doi.org/10.3174/ajnr.A8524","url":null,"abstract":"<p><strong>Background and purpose: </strong>Paramagnetic rim lesions (PRLs) are an imaging biomarker of chronic inflammation in MS that are associated with more aggressive disease. However, the precise tissue characteristics and extent of their damage, particularly with regard to connected axonal tracts, are incompletely understood. Quantitative diffusion tissue measurements and fiber tractography can provide a more complete picture of these phenomena.</p><p><strong>Materials and methods: </strong>One hundred fifteen people with MS were enrolled in this study. Quantitative susceptibility mapping and DWI were acquired on a 3T MRI scanner. PRLs were identified in 49 (43%) subjects. Diffusion tractography was then used to identify nearby PRL-connected versus non-PRL connected tracts and PRL-connected versus nonconnected surrounding tracts. DWI metrics, including fractional anisotropy (FA), quantitative anisotropy (QA), mean diffusivity, axial diffusivity, radial diffusivity, isotropy, and restricted diffusion imaging, were compared between these tracts and within PRLs and non-PRL lesions themselves.</p><p><strong>Results: </strong>Tissue within PRLs had significantly lower FA than tissue within non-PRL T2 lesions (<i>P</i> = .04). Tracts connected to PRLs exhibited significantly lower FA (<i>P</i> < .001), higher restricted diffusion imaging (<i>P</i> = .02, and higher Iso values (<i>P</i> = .007) than tracts connected to non-PRL T2 lesions. Only QA was different between tracts connected to PRLs and nonconnected surrounding tracts (<i>P</i> = .003).</p><p><strong>Conclusions: </strong>PRLs are more destructive both within themselves and to surrounding tissue. This damage appears more spatially than axonally mediated.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":"46 3","pages":"611-619"},"PeriodicalIF":0.0,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143559432","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":"Efficacy and safety in the use of Pipeline Vantage Shield stent versus Pipeline Flex Shield stent in the treatment of patients with unruptured intracranial aneurysms: a multicenter study.","authors":"Andrés J Catalá, Andrés F Ortiz-Giraldo, María F Estévez-Ochoa, Camilo S Alvarado-Bedoya, Jose R Muñoz Ordoñez, Juan A Mejía, Laura Campaña Perilla, Carlos Daz Pacheco, Alfredo Hernandez Ruiz, Juan Gonzalo Muñoz, Sydney Goldfeder de Gracia, Sergio E Serrano-Gomez, Adriana Reyes-Gonzalez, Carlos A Ferreira, Oliverio Vargas, Daniel Mantilla-García","doi":"10.3174/ajnr.A8719","DOIUrl":"https://doi.org/10.3174/ajnr.A8719","url":null,"abstract":"<p><strong>Background and purpose: </strong>Unruptured intracranial aneurysms are pathological bulging of the arterial walls that could rupture and cause subarachnoid hemorrhage. Recently, stents with modified surfaces have been used as treatment for intracranial aneurysms. Thus, comparing efficacy and security of the Pipeline Flex Embolization Device with Shield Technology (PED-Shield) and the Pipeline Vantage Embolization Device with Shield Technology (PEDV) contributes to the scientific literature. Aiming to determine the efficacy of these stents, we believe the PEDV is as effective and safe as the PED-Shield in management of patients with unruptured aneurysms.</p><p><strong>Materials and methods: </strong>We analyzed data through an anonymized, multicentered cohort from multiple interventional radiology services in Colombia from January 2017 until June 2023.</p><p><strong>Results: </strong>Our study included 574 unruptured intracranial aneurysms in 546 patients. At 12 months, overall adequate O'Kelly-Marotta grading scale (OKM=C-D) angiographic results was 83%. For the PEDV stent was 97% and for the PED-Shield stent 80% (p=<0.001). Mortality (0.9%, p=0.34) and overall morbidity 0.5% (PEDV 0.3% and 0.2% PED-Shield). Overall complications events were 3.1%, thromboembolic events were 2.1% in the PED-Shield stent, and 6.7% in the PEDV stent (p=0.008). (p=0.34) Overall bleeding complications were 1.7%, in the PED-Shield stent (0.9%) and two in the PEDV stent (1.4%).</p><p><strong>Conclusions: </strong>The PEDV stent improved efficacy in comparison with PED-Shield stent at 12-months while the PED-Shield stent showed a slightly better safety profile.</p><p><strong>Abbreviations: </strong>ICA= Internal carotid artery; AcomA= Anterior communicating artery; ACA= Anterior cerebral artery; PCA= Posterior cerebral artery; aSAH= Aneurysmal subarachnoid hemorrhage; FDS= flow-diverting stents; IA= Intracranial aneurysm; PEDV= Pipeline Vantage Embolization Device with Shield Technology; PED-Shield= Pipeline Flex Embolization Device with Shield Technology; DAPT= Dual antiplatelet therapy; PcomA= Posterior communicating artery.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143506693","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":"Patterns of Epidural Patch Distribution: The Influence of Spinal Level, Injection Technique, and Patch Volume/Composition on Craniocaudal and Ventral Epidural Dispersion.","authors":"Daniel Montes, Samantha L Pisani Petrucci, Debayan Bhaumik, Nadya Andonov, Peter Lennarson, Andrew L Callen","doi":"10.3174/ajnr.A8720","DOIUrl":"https://doi.org/10.3174/ajnr.A8720","url":null,"abstract":"<p><strong>Background and purpose: </strong>Epidural patching with autologous blood and/or fibrin sealant is a common treatment for spinal cerebrospinal fluid (CSF) leaks, yet the factors influencing patch distribution remain poorly understood. This study aimed to analyze the craniocaudal (CC) and ventral epidural (VE) extent of epidural patch material and investigate the impact of variables such as patch volume, composition, spinal level of injection, and patient habitus on distribution patterns.</p><p><strong>Materials and methods: </strong>This retrospective, cross-sectional cohort study included patients who underwent CT-guided epidural patching from January to September 2024. Inclusion criteria were age ≥18 years, dorsal interlaminar (DI) or transforaminal (TFO) epidural patching using blood, fibrin, or both, and immediate post-patch imaging capturing the entire patch extent. Patch distribution was assessed for CC and VE spread. Statistical analyses included linear and logistic regression models, with multivariate analyses adjusting for confounders.</p><p><strong>Results: </strong>Of 152 patients patched during the study period, 33 met inclusion criteria (mean age 45.4 years; 84.1% female) with 44 spinal levels patched: cervical (6.8%), thoracic (68.2%), and lumbar (25%). Mean patch volume (PV) per needle was 7.2 mL, with a mean CC spread of 4.6 spinal levels. There was a positive relationship between PV and CC spread across all spinal levels (β = 0.29, p = 0.001). Patches in the cervical region demonstrated the highest CC spread efficiency (0.77 levels/mL) compared to thoracic (0.56 levels/mL) and lumbar patches (0.47 levels/mL; p < 0.01). DI injections achieved greater CC spread but less VE dispersion than TFO injections (5.0 vs. 3.2 levels; p = 0.02; 58.8% vs 70.0%, p = 0.52). VE spread occurred in 61.4% of cases and followed a non-linear pattern along the spine, with an inflection point at T3.</p><p><strong>Conclusions: </strong>The distribution of epidural patch material is influenced by spinal level, PV, composition, and injection approach. Cervical patches provide the greatest spread efficiency relative to volume, while DI approaches enhance craniocaudal spread but reduce ventral dispersion.</p><p><strong>Abbreviations: </strong>CSF = cerebrospinal fluid; CC = craniocaudal; VE = ventral epidural; DI = dorsal interlaminar; TFO = transforaminal.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143506701","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":"Diagnostic Performance of Ultrasound in Neck Node NIRADS Category 2.","authors":"Richard Dagher, Alexander Khalaf, Susana Calle, Samir A Dagher, Komal B Shah, Amy Juliano, Ashley H Aiken, Kim O Learned","doi":"10.3174/ajnr.A8717","DOIUrl":"https://doi.org/10.3174/ajnr.A8717","url":null,"abstract":"<p><strong>Background and purpose: </strong>The NI-RADS scoring system standardized imaging surveillance of head and neck (H&N) cancer with risk classification. A nodal NIRADS score of 2 on contrast-enhanced CT (CECT) of the neck indicates low suspicion for recurrence/persistent disease and close follow-up or addition of PET are recommended. The unclear follow-up imaging findings and/or mild FDG uptake raise patient's anxiety of potential delay in diagnosis and intervention while adding high imaging cost. Therefore, at our institution, diagnostic US/US-guided fine needle aspiration (US-FNA) is incorporated in our paradigm. We aim to evaluate US performance in nodal NI-RADS 2 on CECT as alternative valuable tool in surveillance imaging guidelines.</p><p><strong>Materials and methods: </strong>We conducted a retrospective database search (2019-2024) for patients with primary H&N cancer (excluding thyroid cancer and melanoma), a single index neck node NI-RADS 2 on surveillance CECT neck, and a neck US/US-FNA performed within 3 months afterwards for evaluation of the NI-RADS 2 node. We categorized US/US-guided FNA results as positive or negative and reviewed clinical and imaging follow-up, management and nodal disease status up to 1 year following US. The incidence of nodal recurrence and US diagnostic performance were evaluated.</p><p><strong>Results: </strong>Of 90 patients, 36 (40%) had normal diagnostic US with no FNA performed and were thus considered negative, and 54 patients (60%) had abnormal US and hence concurrent US-FNA. 18 (33.3%) US-FNAs were positive for tumor; 27 with normal lymphoid tissue and 9 with indeterminate cytology (no viable malignant cells, acellular or atypia) were considered negative (66.7%). All positive US-FNAs resulted in management changes. 2 patients with normal diagnostic US, 1 with negative FNA and 1 with indeterminate FNA developed recurrence in these nodes within 1 year. The incidence of US-detected malignancy was 20% in patients with a nodal NIRADS 2, surpassing the published rate of 14.3%. The sensitivity, accuracy and NPV of US/US-FNA in detecting tumor recurrence/persistence in nodal NI-RADS 2 are 81.8%, 95.6% and 94.4% respectively.</p><p><strong>Conclusions: </strong>Ultrasound demonstrated good diagnostic performance in the detection of nodal recurrence in patients with NI-RADS 2 on CECT. Its role as an alternative tool in surveillance should be considered.</p><p><strong>Abbreviations: </strong>CECT = contrast-enhanced CT; CEMR = contrast-enhanced MR; ENE = extranodal extension; FNA = fine-needle aspiration; NI-RADS = Neck Imaging Reporting and Data System; NPV = negative predictive value; PPV = positive predictive value; SCC = squamous cell carcinoma; RVU = relative value units; US = ultrasound.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143494904","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}