AJNR. American journal of neuroradiology最新文献

{"title":"The Role of Ferumoxytol-Enhanced MR Venography in Transvenous Embolization of Cerebrospinal Fluid-Venous Fistulas.","authors":"Javier L Galvan, Theodore W Hagens, Rola Saouaf, Wouter I Schievink, Marcel M Maya","doi":"10.3174/ajnr.A8837","DOIUrl":"https://doi.org/10.3174/ajnr.A8837","url":null,"abstract":"<p><strong>Background: </strong>Spontaneous intracranial hypotension (SIH) often results from cerebrospinal fluid-venous fistulas (CVFs), and transvenous embolization is an effective treatment. Precise preprocedural venous mapping is crucial to optimize outcomes and mitigate risks.</p><p><strong>Purpose: </strong>To evaluate the utility of Ferumoxytol-enhanced MR venography (MRV) in delineating venous anatomy for preprocedural planning in CVF treatment.</p><p><strong>Materials and methods: </strong>This retrospective study included 57 participants referred for paraspinal venous embolization between July 2021 and February 2024. Participants were categorized into three groups: SIH with confirmed CVFs, SIH without identified CVFs, and behavioral variant frontotemporal dementia (bvFTD) without CVFs. All participants underwent Ferumoxytol-enhanced MRV to assess venous anatomy.</p><p><strong>Results: </strong>The cohort had mean age of 56.4 years (range, 18-86 years) and included 31 women and 26 men. Identified findings included a high prevalence of lumbar segmental veins draining directly into the inferior vena cava (93%), lumbar segmental veins draining into the left renal vein (54%), and incomplete ascending lumbar veins (63%). Other findings included a duplicated inferior vena cava (1.8%) and the pathological condition azygos vein stenosis (7%). Preprocedural MRV effectively identified venous variations, guiding tailored intervention strategies, and minimizing procedural risks.</p><p><strong>Conclusions: </strong>Ferumoxytol-enhanced MRV provides comprehensive venous mapping, facilitating safer and more efficient planning for CVF treatment.</p><p><strong>Abbreviations: </strong>bvFTD = behavioral variant frontotemporal dementia; CTM = CT myelography; CVF(s) = cerebrospinal fluid-venous fistula(s); DSM = digital subtraction myelography; FS = fat saturated; SIH = spontaneous intracranial hypotension; VIBE = volumetric interpolated breath-hold.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144086792","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":"Transvenous Embolization vs. Surgical Intervention for cerebrospinal fluid Venous Fistulas: A Systematic Review and Meta-analysis.","authors":"Seyed Behnam Jazayeri, Mohammad Mirahmadi Eraghi, Julien Ognard, Sherief Ghozy, Ramanathan Kadirvel, Waleed Brinjikji, David F Kallmes","doi":"10.3174/ajnr.A8839","DOIUrl":"https://doi.org/10.3174/ajnr.A8839","url":null,"abstract":"<p><strong>Background: </strong>The efficacy and safety profiles of surgical and embolization techniques for cerebrospinal venous fistulas (CVFs) in patients with spontaneous intracranial hypotension (SIH) are not well-defined due to limited data and a lack of randomized trials.</p><p><strong>Purpose: </strong>This systematic review and meta-analysis aims to compare the efficacy and safety of surgical treatment and transvenous embolization for CVFs in patients with SIH.</p><p><strong>Data sources: </strong>PubMed, Embase, and Scopus were searched from inception to September 2024.</p><p><strong>Study selection: </strong>Clinical studies involving adults with confirmed CVFs, treated either surgically or through transvenous embolization, were included. Endpoints analyzed included headache response, overall symptom resolution, radiologic treatment response, and complications. Meta-analyses were performed using R software, applying random effects models to calculate prevalence rates and their 95% confidence intervals (CIs). Subgroups of surgery and embolization were compared using Chi-square test. The quality of the studies was assessed using appropriate checklists.</p><p><strong>Data analysis: </strong>Fifteen studies involving 321 patients and 354 CVFs were included, all of good quality. Both treatment modalities led to over 90% partial or complete headache response, with no significant difference between embolization (93.9%; 95% CI 88.3% to 96.9%) and surgery (90.1%; 95% CI 75.6% to 96.4%) (p=0.43). Overall symptom resolution (complete response) was also comparable between embolization (59.1%; 95% CI 50.5% to 67.1%) and surgery (70.7%; 95% CI 44.7% to 87.8%) (p=0.38). Radiologic response, measured by the Bern score, showed significant improvement post-embolization, with no corresponding data from surgical literature. The retreatment/recurrence rate was 14% (95% CI: 9.9% to 19.3%), with no significant difference between embolization (15.3%; 95% CI 10.3% to 22.1%) and surgery (11.3%; 95% CI 5.7% to 20.9%) (p=0.63). There was no publication bias among the reported endpoints.</p><p><strong>Limitations: </strong>Lack of direct comparative effectiveness and small sample sizes heighten the risk of selection and confounding bias.</p><p><strong>Conclusions: </strong>In conclusion, our systematic review and meta-analysis indicate that both surgical treatment and transvenous embolization for CVFs in patients with SIH provide comparable efficacy and safety profiles. Future research should employ uniform definitions, standardized radiologic and clinical endpoints, and long-term follow-up to more rigorously evaluate the relative efficacy and safety of these approaches.</p><p><strong>Abbreviations: </strong>SIH =Spontaneous intracranial hypotension; CVF =CSF-venous fistulas; EBP =Epidural blood patching.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144086721","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":"State of Practice of Neuroradiology Fellowship Programs: A Comprehensive Guide for Neuroradiology Fellowship Program Directors.","authors":"Mari Hagiwara, Ranliang Hu, Alok A Bhatt, Ashesh A Thaker, Erik H Middlebrooks, Ashley H Aiken, Tabassum A Kennedy","doi":"10.3174/ajnr.A8838","DOIUrl":"https://doi.org/10.3174/ajnr.A8838","url":null,"abstract":"<p><p>The scope of responsibilities and time commitment required for program directors (PDs) of Neuroradiology fellowship programs has become quite substantial over the past decade. PDs must continually refine and document a robust, effective curriculum that meets growing accreditation requirements while aligning with institution policies and workflow. This article serves as a comprehensive guide for Neuroradiology fellowship PDs, providing direction and resources needed to lead a successful and compliant fellowship program.ABBREVIATIONS: ACGME = Accreditation Council for Graduate Medical Education; ADS = Accreditation Data System; ASNR = American Society of Neuroradiology; CCC = Clinical Competency Committee; ERAS = Electronic Residency Application Service; GMEC = Graduate Medical Education Committee; NRMP = National Residency Match Program; PEC = Program Evaluation Committee; PD = Program Director; SCARD = Society of Chairs of Academic Radiology Departments.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144086789","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":"Reporting the Degree of Certainty of CSF-Venous Fistulas in Patients with Spontaneous Intracranial Hypotension: The Duke CSF-Venous Fistula Confidence Score.","authors":"Timothy J Amrhein, Daphne Zhu, Linda Gray, Kayla W Kilpatrick, Al Erkanli, Jay Willhite, Michael D Malinzak, Peter G Kranz","doi":"10.3174/ajnr.A8835","DOIUrl":"https://doi.org/10.3174/ajnr.A8835","url":null,"abstract":"<p><strong>Background and purpose: </strong>CSF-venous fistulas (CVFs) are a common cause of spontaneous intracranial hypotension (SIH). CVF identification and localization are critical for diagnosis and treatment, but inconsistent visualization of CVFs on myelography leads to diagnostic uncertainty. Diagnostic confidence impacts treatment decisions. However, there is currently no standardized method for reporting the degree of confidence about the presence or absence of a CVF on CT myelography (CTM). The purposes of this study are to present a novel instrument to provide structured communication of the degree of certainty about the presence of a CVF, and to determine the inter-reader and intra-reader agreement of this scoring system for determining the presence of a CVF at a given spinal level on CTMs.</p><p><strong>Materials and methods: </strong>This retrospective study assessed the inter-reader and intra-reader reproducibility of a scoring system anchored in previously reported objective imaging findings, including the attenuation of paraspinal veins associated with CVFs. We included CTMs from patients with SIH performed between 10/2017-03/2024 at one institution. Exclusion criteria were CSF leak other than CVF, prior transvenous embolization, and non-diagnostic CTMs. Several potential iterations of the scoring system were developed. The study cohort consisted of a balanced set of cases representative of varying degrees of certainty: definite, high probability, low probability, and negative (25 each). Five radiologists (3-19 years experience) provided their blinded subjective confidence assessment and then applied the scoring system. Inter-reader and intra-reader agreements were calculated for the different scoring system models using kappa statistics.</p><p><strong>Results: </strong>The best-performing model produced substantial mean intra-reader agreement, closely approximated the number of definite CVFs, and was adopted as the final model. Inter-reader agreement for the adopted model was moderate, replicating that for the subjective interpretations. Other versions of the model produced fair-to-moderate inter-reader agreements and were not adopted.</p><p><strong>Conclusions: </strong>We developed a structured reporting system anchored in objective imaging findings that communicates the degree of certainty about the presence of CVF on CTM. This system replicates assessments by expert readers and meets a critical need for improved communication both in daily clinical practice and in research by providing a method for objectively quantifying the certainty of CVF diagnosis.</p><p><strong>Abbreviations: </strong>CTM = CT myelography; CVF = CSF-venous fistula; DCCS = Duke CSF-Venous Fistula Confidence Score; DSM = digital subtraction myelography; EBP = epidural blood patching; HPVS = Hyperdense paraspinal vein sign; SIH = Spontaneous intracranial hypotension; TVE = transvenous embolization.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144025936","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":"Optimising CT Perfusion (CTP) in Posterior circulation infarction (POCI): A comprehensive analysis of CTP postprocessing algorithms for POCI.","authors":"Leon S Edwards, Cecilia Cappelen-Smith, Dennis Cordato, Andrew Bivard, Leonid Churilov, Longting Lin, Chushuang Chen, Carlos Garcia-Esperon, Mark W Parsons","doi":"10.3174/ajnr.A8833","DOIUrl":"https://doi.org/10.3174/ajnr.A8833","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background and purpose: &lt;/strong&gt;CTP Software packages utilise various mathematical techniques to transform source data into clinically useful maps. These techniques have not been validated for Posterior circulation infarction (POCI). Studies of anterior circulation stroke have shown that algorithm differences significantly influence the accuracy and best tissue parameters and thresholds of output maps. We examined the influence of the processing algorithm on CTP accuracy and best tissue parameters and thresholds in acute POCI.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Materials and methods: &lt;/strong&gt;Data were analysed from patients diagnosed with a POCI enrolled in the International-stroke-perfusionimaging-registry (INSPIRE). Fifty-eight-patients with baseline multimodal-CT with occlusion of a large posterior-circulation artery and follow up diffusion-weighted-MRI at 24-48 hours were included. CTP parametric maps were generated using five algorithms; Singular value deconvolution, Singular value deconvolution with delay and dispersion correction (SVDd), Partial-deconvolution, Stroke-stenosis and Maximum Slope models. Receiver operating curve (ROC) analysis and linear regression were used for voxel-based analysis and volume-based analysis respectively.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Partial-deconvolution using the Mean Transit Time (MTT) parameter was the optimal technique for characterising ischaemic-penumbra (AUC=0.73 [0.64-0.81]) and infarct-core (AUC=0.70 [0.63-0.73]). The optimal MTT threshold was &gt;165% and &gt;180% for core and penumbra respectively. The optimal MTT threshold was &gt;165% and &gt;180% for core and penumbra respectively. By volume analysis; the SVDd and Maximum Slope (MS) using MTT were the best algorithms for estimation of penumbra and core respectively. Estimates of core volume were weak (all R&lt;sup&gt;2&lt;/sup&gt;&lt;0.02). Processing algorithm influenced model accuracy (AUC-range: 0.700.73 [core], 0.67-0.72 [penumbra]) and optimal tissue parameter and threshold. MTT was the most consistent optimal parameter across algorithms. The optimal MTT threshold varied from &gt;120% to &gt;200% for core and 155% to 195% for penumbra.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;CTP has diagnostic utility in POCI. There were notable differences in optimal parameter and threshold by algorithm. Clinicians should be aware of the specific algorithm used in their CTP processing software and apply caution when comparing output maps between vendors.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Abbreviations: &lt;/strong&gt;CTP = CT Perfusion; POCI = Posterior circulation infarction, ACS = Anterior circulation stroke, ROC = Reciever operating curve, AUC = Area under the curve, SVD = Singular value deconvolution, SVDd = Singular value deconvolution with delay and dispersion correction, MTT = Mean transit Time, TTP = Time to Peak, DT = Delay time, TMax = Time to maximum of the tissue resiude curve, CBV = Cerebral blood volume, CBF = Cerebral blood flow, AIF = Arterial input function, VOF = Venous output function, EVT = endovascula","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144059505","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":"ihtObtura®, a new liquid embolic agent for improving curative embolization of brain AVMs.","authors":"Juan C Llibre-Guerra, Adnan H Siddiqui, Leopoldo Guimaraens, Rene Chapot, Alberto Gil","doi":"10.3174/ajnr.A8834","DOIUrl":"https://doi.org/10.3174/ajnr.A8834","url":null,"abstract":"<p><strong>Background and purpose: </strong>We report our initial experience with ihtObtura®, a novel non-adhesive liquid embolic agent with progressive post-embolization loss of radiopacity for curative embolization of brain arteriovenous malformations (bAVMs).</p><p><strong>Materials and methods: </strong>A post-hoc analysis of the Claridad trial, a single center, first-in-man study was performed. Collected data on consecutive brain bAVMs patients treated with ihtObtura® (between November 2021 to September 2022) were analyzed. Patient demographics, AVM characteristics, procedure details, and clinical treatment outcomes were collected. Imaging endpoints included complete occlusion rate at 6 months and loss of radiopacity at 4 -6 weeks.</p><p><strong>Results: </strong>A total of 42 consecutive brain bAVM patients who underwent 102 embolization procedures were included in the analysis. Most patients presented with intracranial hemorrhage (83%). The mean AVM classification was Spetzler-Martin (S-M) grade III-IV (90%), with a mean nidus size of 39 ± 14 mm. Complete occlusion was achieved in 26/28 patients (93%) who were able to complete all treatments during the study period. In the entire patient cohort, complete occlusion was observed in 62% (26/42 patients). Procedure-related disabling permanent neurological deficit and procedure-related death were observed in one case each. Both events were related to postembolization intracranial hemorrhages. Progressive reduction of embolic material radiopacity was observed in all patients.</p><p><strong>Conclusions: </strong>ihtObtura® is a new liquid embolic agent with similar properties as currently available other ethylene vinyl alcohol (EVOH) copolymer based liquid embolics with one major innovation, progressive reduction in embolic material radiopacity. This feature significantly improves anatomical understanding of residual AVM components during staged treatment of AVMs. This study provides initial evidence that combination of EVOH based diffusion properties with progressive loss of radiopacity allows for the potential improvement in rates of complete obliteration for bAVMs.</p><p><strong>Abbreviations: </strong>bAVMs = Brain arteriovenous malformations; S-M = Spetzler-Martin Scale; EVOH = Ethylene vinyl alcohol copolymer; MRI = Magnetic resonance imaging; CT = Computed Tomography; LEA = Liquid embolic agents; mRS = Modified Rankin Scale scores; DMSO = Dimethyl sulpha-oxide solvent; DSA = Digital subtraction angiography.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144037465","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":"Clinical Implementation of Dynamic Parallel Transmission in 7T Brain MRI: Improved Homogeneity and Contrast Using SPACE Sequences.","authors":"Erik H Middlebrooks, Jürgen Herrler, Gian Franco Piredda, Shengzhen Tao, Jun Ma, Vishal Patel, Zeyu Liu, Erin M Westerhold, Xiangzhi Zhou","doi":"10.3174/ajnr.A8827","DOIUrl":"https://doi.org/10.3174/ajnr.A8827","url":null,"abstract":"<p><strong>Background and purpose: </strong>The adoption of routine clinical 7T MRI has been constrained by several challenges, with heterogeneity of the transmit field (B1+) being among the most notable. Dynamic parallel transmission (pTx) presents a promising strategy to enhance B1+ transmit homogeneity; however, associated technical challenges have limited its routine use.We assess performance of a prototype dynamic pTx implementation for 3D sampling perfection with application-optimized contrasts using different flip angle evolution (SPACE) sequence and hypothesize that signal homogeneity and tissue contrast will improve versus single transmit mode (sTx).</p><p><strong>Materials and methods: </strong>Data from consecutive clinical patients undergoing 7T brain MRI for various indications were utilized. Signal homogeneity was assessed using coefficient of variation (CoV). Tissue contrast was assessed using an image intensity profile along an 8mm line crossing the cortex into underlying white matter. Additionally, stability of signal homogeneity across a larger cohort of clinical patients was assessed with CoV. Predicted local specific absorption rate (SAR) for the head between pTx and sTx sequences was also compared.</p><p><strong>Results: </strong>For each sequence, 11 patients had both sTx and pTx scans. The comparison clinical cohort had 40 patients with pTx for each sequence. Image signal and contrast were significantly improved with pTx versus sTx for both T2-SPACE and FLAIR-SPACE (p=0.001). Tissue contrast between white matter and cortex was also significantly improved in the temporal lobe with pTx (p=0.001). CoV did not reveal any outlier cases across a large clinical cohort, demonstrating consistency in signal homogeneity. Despite increased SAR, T2-SPACE pTx consistently operated in first-level controlled mode, while FLAIR-SPACE pTx scans generally operated in normal mode.</p><p><strong>Conclusions: </strong>We demonstrate the feasibility of a time-efficient prototype dynamic pTx implementation in T2-SPACE and FLAIRSPACE sequences, which significantly enhances signal and contrast across the brain compared to sTx, while exhibiting consistent and robust performance in a large cohort of clinical patients.</p><p><strong>Abbreviations: </strong>BRISQUE = Blind/Referenceless Image Spatial Quality Evaluator; CoV = coefficient of variation; FOCUS = fast online-customized pulses; GM = gray matter; NIQE = Natural Image Quality Evaluator; pTx = parallel transmit mode; RF = radiofrequency; SAR = specific absorption rate; SPACE = 3D sampling perfection with application-optimized contrasts using different flip angle evolution; sTx = single transmit mode; WM = white matter.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144063499","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 Role of MRA as a Preliminary Diagnostic Tool in Diagnosing and Localizing Spinal Dural Arteriovenous Fistula (SDAVF).","authors":"Efrat Saraf-Lavi, Julieta Aristizabal, Dileep R Yavagal, Robert M Starke, Adham M Khalafallah, Allan D Levi, Richard J T Gorniak","doi":"10.3174/ajnr.A8830","DOIUrl":"https://doi.org/10.3174/ajnr.A8830","url":null,"abstract":"<p><strong>Background and purpose: </strong>Despite advances in imaging techniques, spinal dural arteriovenous fistulas may be misdiagnosed, leading to delays in treatment and in some cases irreversible neurological damage. Spinal DSA has been considered the gold standard in diagnosing spinal dural arteriovenous fistula; however, it is operator dependent and often technically difficult, which can result in false negative studies. MRI/MRA has been established as a sensitive and specific imaging technique in diagnosing spinal dural arteriovenous fistula (SDAVF) and in identifying the correct level of the fistula. We present our experience with diagnosing SDAVF using MRI/MRA and propose MRA as a complementary imaging modality to DSA in diagnosing and localizing SDAVF.</p><p><strong>Materials and methods: </strong>Once institutional review board approval was granted, data was retrospectively collected from records of 30 patients with surgically proven cases of type I SDAVFs at a large tertiary academic center. This search included records from 2010 to 2024. Eligibility criteria included any patient with a surgically proven SDAVF, or patients treated by embolization for SDAVF in whom preoperative MRI and DSA had been obtained. Of these patients, 15 had preoperative spinal MRA. The demographic variables collected included patient age, sex, prior spine surgery history, symptomatology, and outcomes.</p><p><strong>Results: </strong>In all 30 patients, a spinal dural arteriovenous fistula was suggested on routine MRI. In 7 cases, DSA was negative. In all 15 patients who had MRA before treatment at our institution, the MRA was positive for spinal dural arteriovenous fistulas. In 3 cases the MRA was done after DSA at our institution failed to identify the spinal dural arteriovenous fistulas and the patient was taken to surgery based on the MRA results alone. In 4 patients with outside institution negative DSAs, MRAs at our institution were positive and subsequently had positive DSA.</p><p><strong>Conclusions: </strong>Our findings suggest that MRA is a highly sensitive tool for detecting SDAVF and should be used before DSA, to decrease the likelihood of false negative DSAs. A limited spinal DSA may also be considered in cases where MRA clearly identifies the fistula level.</p><p><strong>Abbreviations: </strong>SDAVF=spinal dural arteriovenous fistula; SVS=spinal vascular shunts; TWIST=time-resolved angiography with interleaved stochastic trajectories; VIBE=volumetric interpolated breath-hold examination.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144053418","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":"Baseline Gadolinium Enhancement of the Intracranial Aneurysm Wall and Three-Dimensional Morphological Change During Long-Term Follow-Up.","authors":"Maarten J Kamphuis, Laura T van der Kamp, Jari T van Vliet, Ruben P A van Eijk, Jeroen Hendrikse, Gabriel J E Rinkel, Mervyn D I Vergouwen, Irene C van der Schaaf","doi":"10.3174/ajnr.A8825","DOIUrl":"https://doi.org/10.3174/ajnr.A8825","url":null,"abstract":"<p><strong>Background and purpose: </strong>Previous studies showed that intracranial aneurysm wall enhancement (AWE) is associated with aneurysm growth or rupture. These studies assessed growth with manual 2D measurements or eyeballing, both of which are prone to interobserver variability. To minimize this variability, we assessed the association between AWE and semi-automatically quantified 3D morphological changes in aneurysms during long-term follow-up.</p><p><strong>Materials and methods: </strong>We included patients with an unruptured intracranial aneurysm who had baseline MR aneurysm wall imaging and were followed with MR or CT angiography for ≥1 year. We used in-house-developed software to measure six 3D morphological parameters on paired baseline and follow-up scans and determined changes over time. We compared the proportion of aneurysms showing morphological change (modified Z-score <-3.5 or >+3.5) between aneurysms with and without AWE. The risk difference with 95% CI was calculated for each morphological parameter. For parameters with a statistically significant change difference between aneurysms with and without AWE, we calculated ORs with 95% CI in a univariable logistic regression model, and adjusted for aneurysm size in a bivariable model.</p><p><strong>Results: </strong>Sixty-two patients with 72 unruptured intracranial aneurysms met inclusion criteria. Twenty aneurysms (28%) in 18 patients showed AWE at baseline. Median follow-up was 5.8 years (IQR 4.6-6.6). For the parameter curvedness, the proportion of aneurysms showing an increase was higher in aneurysms with AWE (6 of 20, 30%) than aneurysms without AWE (2 of 52, 4%), with a risk difference of 26% (95%CI 9-49%). For the other five morphological parameters, the proportion of aneurysms with morphological change was comparable between aneurysms with and without AWE. In logistic regression analysis, AWE was associated with curvedness increase (crude OR 10.7 [95%CI 2.2-78.9], adjusted OR 6.1 [95%CI 1.01-50.3]).</p><p><strong>Conclusions: </strong>AWE was associated with aneurysm shape change during long-term follow-up, with an increase in 3D quantified curvedness that was independent of aneurysm size. This reinforces previous findings that AWE is associated with aneurysm instability, in particular curvedness increase, and suggests that curvedness could be a suitable parameter to capture aneurysm instability. Future studies need to investigate whether an increase in this parameter predicts aneurysmal rupture.</p><p><strong>Abbreviations: </strong>AWE = aneurysm wall enhancement; AWI = aneurysm wall imaging; IBSI = imaging biomarker standardization initiative; UIA = unruptured intracranial aneurysm.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143993972","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Automated Detection of Black Hole Sign for Intracerebral Hemorrhage Patients Using Self-Supervised Learning.","authors":"Hanyin Wang, Tim Schwirtlich, Ethan J Houskamp, Meghan R Hutch, Julianne X Murphy, Juliana S do Nascimento, Andrea Zini, Laura Brancaleoni, Sebastiano Giacomozzi, Yuan Luo, Andrew M Naidech","doi":"10.3174/ajnr.A8826","DOIUrl":"https://doi.org/10.3174/ajnr.A8826","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background and purpose: &lt;/strong&gt;Intracerebral Hemorrhage (ICH) is a devastating form of stroke. Hematoma expansion (HE), growth of the hematoma on interval scans, predicts death and disability. Accurate prediction of HE is crucial for targeted interventions to improve patient outcomes. The black hole sign (BHS) on non-contrast computed tomography (CT) scans is a predictive marker for HE. An automated method to recognize the BHS and predict HE could speed precise patient selection for treatment.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Materials and methods: &lt;/strong&gt;In. this paper, we presented a novel framework leveraging self-supervised learning (SSL) techniques for BHS identification on head CT images. A ResNet-50 encoder model was pre-trained on over 1.7 million unlabeled head CT images. Layers for binary classification were added on top of the pre-trained model. The resulting model was fine-tuned using the training data and evaluated on the held-out test set to collect AUC and F1 scores. The evaluations were performed on scan and slice levels. We ran different panels, one using two multi-center datasets for external validation and one including parts of them in the pre-training RESULTS: Our model demonstrated strong performance in identifying BHS when compared with the baseline model. Specifically, the model achieved scan-level AUC scores between 0.75-0.89 and F1 scores between 0.60-0.70. Furthermore, it exhibited robustness and generalizability across an external dataset, achieving a scan-level AUC score of up to 0.85 and an F1 score of up to 0.60, while it performed less well on another dataset with more heterogeneous samples. The negative effects could be mitigated after including parts of the external datasets in the fine-tuning process.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;This study introduced a novel framework integrating SSL into medical image classification, particularly on BHS identification from head CT scans. The resulting pre-trained head CT encoder model showed potential to minimize manual annotation, which would significantly reduce labor, time, and costs. After fine-tuning, the framework demonstrated promising performance for a specific downstream task, identifying the BHS to predict HE, upon comprehensive evaluation on diverse datasets. This approach holds promise for enhancing medical image analysis, particularly in scenarios with limited data availability.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Abbreviations: &lt;/strong&gt;ICH = Intracerebral Hemorrhage; HE = Hematoma Expansion; BHS = Black Hole Sign; CT = Computed Tomography; SSL = Self-supervised Learning; AUC = Area Under the receiver operator Curve; CNN = Convolutional Neural Network; SimCLR = Simple framework for Contrastive Learning of visual Representation; HU = Hounsfield Unit; CLAIM = Checklist for Artificial Intelligence in Medical Imaging; VNA = Vendor Neutral Archive; DICOM = Digital Imaging and Communications in Medicine; NIfTI = Neuroimaging Informatics Technology Initiative; INR = International Normaliz","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144053609","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}