AJNR. American journal of neuroradiology最新文献

{"title":"Probabilistic Presurgical Language fMRI Atlas of Patients with Brain Tumors.","authors":"Jian Ming Teo, Vinodh A Kumar, Jina Lee, Rami W Eldaya, Ping Hou, Mu-Lan Jen, Kyle R Noll, Peng Wei, Sherise D Ferguson, Sujit S Prabhu, Max Wintermark, Ho-Ling Liu","doi":"10.3174/ajnr.A8383","DOIUrl":"10.3174/ajnr.A8383","url":null,"abstract":"<p><strong>Background and purpose: </strong>Patients with brain tumors have high intersubject variation in putative language regions, which may limit the utility of straightforward application of healthy subject brain atlases in clinical scenarios. The purpose of this study was to develop a probabilistic functional brain atlas that consolidates language functional activations of sentence completion and Silent Word Generation language paradigms using a large sample of patients with brain tumors.</p><p><strong>Materials and methods: </strong>The atlas was developed using retrospectively collected fMRI data from patients with brain tumors who underwent their first standard-of-care presurgical language fMRI scan at our institution between July 18, 2015, and May 13, 2022. Three hundred seventeen patients (861 fMRI scans) were used to develop the language functional atlas. An independent presurgical language fMRI data set of 39 patients with brain tumors from a previous study was used to evaluate our atlas. Family-wise error-corrected binary functional activation maps from sentence completion, letter fluency, and category fluency presurgical fMRI were used to create probability overlap maps and pooled probabilistic overlap maps in Montreal Neurological Institute standard space. The Wilcoxon signed-rank test was used to determine a significant difference in the maximum Dice coefficient for our atlas compared with a meta-analysis-based template with respect to expert-delineated primary language area activations.</p><p><strong>Results: </strong>Probabilities of activating the left anterior primary language area and left posterior primary language area in the temporal lobe were 87.9% and 91.5%, respectively, for sentence completion, 88.5% and 74.2%, respectively, for letter fluency, and 83.6% and 67.6%, respectively, for category fluency. Maximum Dice coefficients for templates derived from our language atlas were significantly higher than the meta-analysis-based template in the left anterior primary language area (0.351 and 0.326, respectively, <i>P </i>< .05) and the left posterior primary language area in the temporal lobe (0.274 and 0.244, respectively, <i>P </i>< .005).</p><p><strong>Conclusions: </strong>Brain tumor patient- and paradigm-specific probabilistic language atlases were developed. These atlases had superior spatial agreement with fMRI activations in individual patients compared with the meta-analysis-based template.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141422191","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":"Comparing Vascular Morphology and Hemodynamics in Patients with Vein of Galen Malformations Using Intracranial 4D Flow MRI.","authors":"Jeffrey N Stout, Alfred Pokmeng See, Julie Meadows, Shivani D Rangwala, Darren B Orbach","doi":"10.3174/ajnr.A8353","DOIUrl":"10.3174/ajnr.A8353","url":null,"abstract":"<p><strong>Background and purpose: </strong>Vein of Galen malformation (VOGM) is the most common congenital cerebrovascular malformation, and many patients have high mortality rates and poor cognitive outcomes. Quantitative diagnostic tools are needed to improve clinical outcomes, and the purpose of this study was to characterize intracranial blood flow in VOGM using quantitative 4D flow MRI.</p><p><strong>Materials and methods: </strong>A prospective study of children with VOGM was conducted by acquiring 4D flow MRI to quantify total blood inflow to the brain, flow in the pathologic falcine sinus, and flow in the superior sagittal sinus. Linear regression was used to test the relationships between these flows and age, clinical status, and the mediolateral diameter of the outflow tract of the lesion through the falcine or straight sinus diameter, which is a known morphologic prognostic metric.</p><p><strong>Results: </strong>In all 11 subjects (mean age, 22 [SD,17 ] weeks), total blood flow to the brain always exceeded normal levels (mean, 1063 [SD, 403] mL/minute). Significant correlations were observed between falcine sinus flow and the mediolateral diameter of the straight or falcine sinus, the posterior cerebral artery/MCA flow ratio and age at scanning, and superior sagittal sinus flow proximal to malformation inflow and age at scanning.</p><p><strong>Conclusions: </strong>Using 4D flow MRI, we established the hemodynamic underpinnings of the mediolateral diameter of the straight or falcine sinus and investigated metrics representing parenchymal venous drainage that could be used to monitor the normalization of hemodynamics during embolization therapy.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141094793","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":"Revisiting the Pathophysiology of Intracranial Hemorrhage in Fetuses with Chiari II Malformation: Novel Imaging Biomarkers of Disease Severity?","authors":"Hui Shi, Daniela Prayer, Patric Kienast, Farjad Khalaveh, Johannes Tischer, Julia Binder, Michael Weber, Marlene Stuempflen, Gregor Kasprian","doi":"10.3174/ajnr.A8331","DOIUrl":"10.3174/ajnr.A8331","url":null,"abstract":"<p><strong>Background and purpose: </strong>Intracranial hemorrhage (ICH) has emerged as a notable concern in Chiari II malformation (CM II), yet its origins and clinical implications remain elusive. This study aims to validate the in utero prevalence of ICH in CM II and investigate contributing factors, and visualize the findings in a network format.</p><p><strong>Materials and methods: </strong>A single-center retrospective review of fetal MRI scans obtained in fetuses with CM II (presenting January 2007 to December 2022) was performed for ICH utilizing EPI-T2* blood-sensitive sequence. Fetuses with aqueduct stenosis (AS) were included as a control group. The incidence of ICH and corresponding gestational ages were compared between CM II and AS cases, and morphometric measurements (inner/outer CSF spaces, posterior fossa, venous structure) were compared among the 4 1:1 age-matched groups: CM II+ICH, CM II-ICH, AS+ICH, and AS-ICH. Additionally, a co-occurrence network was constructed to visualize associations between phenotypic features in ICH cases.</p><p><strong>Results: </strong>A total of 101 fetuses with CM II and 90 controls with AS at a median gestational age of 24.4 weeks and 22.8 weeks (<i>P</i> = .138) were included. Prevalence of ICH in fetuses with CM II was higher compared with the AS cases (28.7% versus 18.9%, <i>P</i> = .023), accompanied by congested veins (deep vein congestion mainly in young fetuses, and cortical veins may also be affected in older fetuses). ICH was notably correlated with specific anatomic features, essentially characterized by reduced outer CSF spaces and clivus-supraocciput angle. The co-occurrence network analysis reveals complex connections including bony defects, small posterior fossa dimensions, vermis ectopia, reduced CSF spaces, as well as venous congestion and venous sinus stenosis as pivotal components within the network.</p><p><strong>Conclusions: </strong>The high prevalence of ICH-detected by fetal MRI-among fetuses with CM emphasizes the pathophysiologic importance of venous congestion, ICH, and vasogenic edema. As indicators of disease severity, these features may serve as helpful additional imaging biomarkers for the identification of potential candidates for fetal surgery.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140890633","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":"Quantitative Susceptibility Mapping in Adults with Persistent-Post Concussion Symptoms after Mild Traumatic Brain Injury: An Exploratory Study.","authors":"Tiffany K Bell, Muhammad Ansari, Julie M Joyce, Leah J Mercier, David G Gobbi, Richard Frayne, Chantel Debert, Ashley D Harris","doi":"10.3174/ajnr.A8454","DOIUrl":"https://doi.org/10.3174/ajnr.A8454","url":null,"abstract":"<p><strong>Background and purpose: </strong>It is estimated that 18-30% of concussion sufferers experience symptoms lasting more than 1 month, known as persistent post-concussion symptoms (PPCS). Symptoms can be debilitating, and include headache, dizziness, nausea, problems with memory and concentration, sleep and mood disruption, and exercise intolerance. Previous studies have used quantitative susceptibility mapping (QSM) to show altered tissue susceptibility levels in adults acutely following concussion, however this finding has yet to be investigated in participants with PPCS.</p><p><strong>Materials and methods: </strong>In this exploratory case-controlled study, we measured tissue susceptibility using quantitative susceptibility mapping (QSM) in 24 participants with PPCS following mild traumatic brain injury (mTBI) and 23 healthy controls with no history of concussion. We compute tissue susceptibility for seven white matter tracts and three deep grey matter regions and compare tissue susceptibility between groups using ANCOVA models controlling for age and sex. We also assess the relationship between regional tissue susceptibility and symptoms.</p><p><strong>Results: </strong>There were no significant differences between tissue susceptibility in participants with PPCS compared to control subjects in any of the evaluated regions. However, we show lower tissue susceptibility across four white matter tracts was generally associated with worse symptoms in the PPCS group. Specifically, we saw relationships between white matter susceptibility and headache (p=0.006), time since injury (p=0.03), depressive symptoms (p=0.021) and daytime fatigue (p=0.01) in participants with PPCS.</p><p><strong>Conclusions: </strong>These results provide evidence in support of persistent changes in the brain months-to-years following injury and highlight the need to further understand the pathophysiology of PPCS, to determine effective prevention and treatment options.</p><p><strong>Abbreviations: </strong>ATR: Anterior Thalamic Radiation; Caud: Caudate; CCB: Corpus Callosum Body; CCG: Corpus Callosum Genus; CCS: Corpus Callosum Splenium; CH: Cingulum; DHI: Dizziness Handicap Inventory; ESS: Epworth Sleepiness Scale; FM: Forceps Minor; FSS: Fatigue Severity Scale; GAD: Generalized Anxiety Disorder; HIT-6: Headache Impact Test 6; IFOF: Inferior Fronto-Occipital Fasciculus; ILF: Inferior Longitudinal Fasciculus; mTBI: mild traumatic brain injury; Pal: Pallidum; PPCS: Persistent Post-Concussive Symptoms; PCSC: Postconcussional Syndrone Checklist; PHQ: Patient Health Questionnaire; Put: Putamen; RPQ: Rivermead Post Concussion Symptoms Questionnaire; SLF: Superior Longitudinal Fasciculus; QSM: Quantitative Susceptibility Mapping.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141997062","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":"Dynamic Expansion and Contraction of Multiple Sclerosis T2-weighted Hyperintense Lesions are Present Below the Threshold of Visual Perception.","authors":"Darin T Okuda, Tatum M Moog, Morgan McCreary, Kevin Shan, Kasia Zubkow, Braeden D Newton, Alexander D Smith, Mahi A Patel, Katy W Burgess, Christine Lebrun-Frénay","doi":"10.3174/ajnr.A8453","DOIUrl":"https://doi.org/10.3174/ajnr.A8453","url":null,"abstract":"<p><strong>Background and purpose: </strong>The study of T2-weighted hyperintense lesions resulting from autoimmune inflammatory injury and associated volumes within the CNS remains fundamental to the diagnosis and disease surveillance of multiple sclerosis (MS). We investigated the dynamic changes of individual T2-weighted hyperintense MS lesions on MRI and hypothesized that variations may be present below the threshold of visual perception when evaluating longitudinal data.</p><p><strong>Materials and methods: </strong>A retrospective study was performed of people with MS, incorporating data from three consecutive MRI time points acquired within a single academic center. All included MRI studies lacked formal imaging interpretations of newly enlarging or contracting T2-weighted hyperintensities. Well defined, non-coalescing, individual T2-weighted hyperintense lesions were targeted. A total of 8-12 lesions were randomly selected in a blinded fashion at MRI time point 1 and 3-dimensional lesion volumes followed over MRI time points 2 and 3. The impact of treatment on lesion expansion and relationship to brain MRI advancement, patient-reported progression of disease, and physician-identified progression was also studied.</p><p><strong>Results: </strong>The study cohort was comprised of 115 people (81 (70.4%) female; mean disease duration of 6.62 years(y) (standard deviation: 6.68y)) who were primarily White (79.1%). A total of 1,426 focal T2-weighted hyperintense MS lesions were identified on MRI time point 1 and longitudinally followed over MRI time points 2 and 3. In the evaluation of raw changes in individual T2-weighted hyperintense lesion volumes from MRI time point 1 to MRI time point 2, a similar number of individuals were observed with predominantly expanding (49/115; 42.6%) or contracting (51/115; 44.3%) lesions. However, the majority of lesions expanded in volume (48/115; 41.7%) versus those that contracted (45/115; 39.1%) when evaluating MRI time point 3 to time point 1. Those individuals not on active treatment had a 67.15% reduction in the odds of more individual lesions predominantly contracting in volume relative to those on low-efficacy disease modifying therapy treatment (95% CI=[-83.89, -33.01], p=0.0008) and 74.02% reduction for those on high-efficacy treatment (95% CI=[-87.37%,-46.56%], p<0.0001).</p><p><strong>Conclusions: </strong>Dynamic changes in T2-weighted hyperintense lesions are abundant, occurring below the threshold of visual perception and are present more frequently in untreated individuals.</p><p><strong>Abbreviations: </strong>MS = multiple sclerosis; DMT = disease modifying therapy; 2D = 2-dimensional; 3D = 3-dimensional; LMS = Lambda, Mu, and Sigma.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141997061","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":"Dextromethorphan Associated Neurotoxicity with Cerebellar Edema (DANCE) Syndrome in Young Children: Neuroimaging Features.","authors":"Smily Sharma, Sarbesh Tiwari, Lokesh Saini, Taruna Yadav, Sujatha Manjunathan, Ananya Panda, Bharat Choudhary, Daisy Khera","doi":"10.3174/ajnr.A8455","DOIUrl":"https://doi.org/10.3174/ajnr.A8455","url":null,"abstract":"<p><p>Dextromethorphan toxicity in young children (especially those with age 4 years or younger) can have an extremely poor prognosis if untreated. However, if timely recognized and optimally managed, it can have a good clinical outcome despite significant initial insult. We present 3 pediatric cases (< 5 years old) with sudden unresponsiveness following ingestion of cough medications containing dextromethorphan. All these children showed cytotoxic edema in cerebellar hemispheres on MR brain, with diffusion restricting foci in supratentorial white matter in 2 patients. These features resemble the recently described acute opioid toxidrome in children, the POUNCE syndrome (Pediatric Opioid Use-associated Neurotoxicity with Cerebellar Edema). Hence, we name this entity \"DANCE\" (Dextromethorphan Associated Neurotoxicity with Cerebellar Edema) to increase the awareness of dextromethorphan toxicity in young children and the need to promptly recognize it to initiate optimal management.ABBREVIATIONS: POUNCE= Pediatric Opioid Use-associated Neurotoxicity with Cerebellar Edema; DANCE= Dextromethorphan Associated Neurotoxicity with Cerebellar Edema.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141997060","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 Denoising Improves CT Perfusion Image Quality in the Setting of Lower Contrast Dosing: A Feasibility Study.","authors":"Mahmud Mossa-Basha, Chengcheng Zhu, Tanya Pandhi, Steve Mendoza, Javid Azadbakht, Ahmed Safwat, Dean Homen, Carlos Zamora, Dinesh Kumar Gnanasekaran, Ruiyue Peng, Steven Cen, Vinay Duddalwar, Jeffry R Alger, Danny J J Wang","doi":"10.3174/ajnr.A8367","DOIUrl":"10.3174/ajnr.A8367","url":null,"abstract":"<p><strong>Background and purpose: </strong>Considering recent iodinated contrast shortages and a focus on reducing waste, developing protocols with lower contrast dosing while maintaining image quality through artificial intelligence is needed. This study compared reduced iodinated contrast media and standard dose CTP acquisitions, and the impact of deep learning denoising on CTP image quality in preclinical and clinical studies. The effect of reduced X-ray mAs dose was also investigated in preclinical studies.</p><p><strong>Materials and methods: </strong>Twelve swine underwent 9 CTP examinations each, performed at combinations of 3 different x-ray (37, 67, and 127 mAs) and iodinated contrast media doses (10, 15, and 20 mL). Clinical CTP acquisitions performed before and during the iodinated contrast media shortage and protocol change (from 40 to 30 mL) were retrospectively included. Eleven patients with reduced iodinated contrast media dosages and 11 propensity-score-matched controls with the standard iodinated contrast media dosages were included. A residual encoder-decoder convolutional neural network (RED-CNN) was trained for CTP denoising using <i>k-</i>space-weighted image average filtered CTP images as the target. The standard, RED-CNN-denoised, and <i>k-</i>space-weighted image average noise-filtered images for animal and human studies were compared for quantitative SNR and qualitative image evaluation.</p><p><strong>Results: </strong>The SNR of animal CTP images decreased with reductions in iodinated contrast media and milliampere-second doses. Contrast dose reduction had a greater effect on SNR than milliampere-second reduction. Noise-filtering by <i>k-</i>space-weighted image average and RED-CNN denoising progressively improved the SNR of CTP maps, with RED-CNN resulting in the highest SNR. The SNR of clinical CTP images was generally lower with a reduced iodinated contrast media dose, which was improved by the <i>k-</i>space-weighted image average and RED-CNN denoising (<i>P </i>< .05). Qualitative readings consistently rated RED-CNN denoised CTP as the best quality, followed by <i>k-</i>space-weighted image average and then standard CTP images.</p><p><strong>Conclusions: </strong>Deep learning-denoising can improve image quality for low iodinated contrast media CTP protocols, and could approximate standard iodinated contrast media dose CTP, in addition to potentially improving image quality for low milliampere-second acquisitions.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141285593","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":"Toward Improved Radiologic Diagnostics: Investigating the Utility and Limitations of GPT-3.5 Turbo and GPT-4 with Quiz Cases.","authors":"Tomohiro Kikuchi, Takahiro Nakao, Yuta Nakamura, Shouhei Hanaoka, Harushi Mori, Takeharu Yoshikawa","doi":"10.3174/ajnr.A8332","DOIUrl":"10.3174/ajnr.A8332","url":null,"abstract":"<p><strong>Background and purpose: </strong>The rise of large language models such as generative pretrained transformers (GPTs) has sparked considerable interest in radiology, especially in interpreting radiologic reports and image findings. While existing research has focused on GPTs estimating diagnoses from radiologic descriptions, exploring alternative diagnostic information sources is also crucial. This study introduces the use of GPTs (GPT-3.5 Turbo and GPT-4) for information retrieval and summarization, searching relevant case reports via PubMed, and investigates their potential to aid diagnosis.</p><p><strong>Materials and methods: </strong>From October 2021 to December 2023, we selected 115 cases from the \"Case of the Week\" series on the <i>American Journal of Neuroradiology</i> website. Their Description and Legend sections were presented to the GPTs for the 2 tasks. For the Direct Diagnosis task, the models provided 3 differential diagnoses that were considered correct if they matched the diagnosis in the diagnosis section. For the Case Report Search task, the models generated 2 keywords per case, creating PubMed search queries to extract up to 3 relevant reports. A response was considered correct if reports containing the disease name stated in the diagnosis section were extracted. The McNemar test was used to evaluate whether adding a Case Report Search to Direct Diagnosis improved overall accuracy.</p><p><strong>Results: </strong>In the Direct Diagnosis task, GPT-3.5 Turbo achieved a correct response rate of 26% (30/115 cases), whereas GPT-4 achieved 41% (47/115). For the Case Report Search task, GPT-3.5 Turbo scored 10% (11/115), and GPT-4 scored 7% (8/115). Correct responses totaled 32% (37/115) with 3 overlapping cases for GPT-3.5 Turbo, whereas GPT-4 had 43% (50/115) of correct responses with 5 overlapping cases. Adding Case Report Search improved GPT-3.5 Turbo's performance (<i>P </i>= .023) but not that of GPT-4 (<i>P </i>= .248).</p><p><strong>Conclusions: </strong>The effectiveness of adding Case Report Search to GPT-3.5 Turbo was particularly pronounced, suggesting its potential as an alternative diagnostic approach to GPTs, particularly in scenarios where direct diagnoses from GPTs are not obtainable. Nevertheless, the overall performance of GPT models in both direct diagnosis and case report retrieval tasks remains not optimal, and users should be aware of their limitations.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140891373","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":"Skull Base CSF Leaks: Potential Underlying Pathophysiology and Evaluation of Brain MR Imaging Findings Associated with Spontaneous Intracranial Hypotension.","authors":"Ian T Mark, Jeremy Cutsforth-Gregory, Patrick Luetmer, Ajay A Madhavan, Michael Oien, Paul Farnsworth, Girish Bathla, Steve Messina, Michael Link, Jamie Van Gompel","doi":"10.3174/ajnr.A8333","DOIUrl":"10.3174/ajnr.A8333","url":null,"abstract":"<p><strong>Background and purpose: </strong>CSF leaks of the skull base and spine share a common process of CSF volume loss, and yet only the latter has been associated with spontaneous intracranial hypotension (SIH). Despite published claims that only spinal leaks cause SIH, no prior studies have evaluated brain MR imaging in patients with skull base leaks for findings associated with SIH, such as dural enhancement. The purpose of our study was to use a validated brain MR imaging scoring system to evaluate patients with skull base CSF leaks for findings associated with SIH.</p><p><strong>Materials and methods: </strong>We included patients with confirmed skull base CSF leaks and contrast-enhanced preoperative brain MRI. The preoperative MR images were reviewed for findings associated with SIH by using the Bern score. Patient age, presenting symptoms and their duration, and leak site were also recorded.</p><p><strong>Results: </strong>Thirty-one patients with skull base CSF leaks were included. Mean Bern score was 0.9 (range 0-4, standard deviation 1.1), and only 1 patient (3%) had dural enhancement. Mean age was 53 years (range 18-76). Mean symptom duration was 1.3 years, with 22 patients presenting within 1 year of symptom onset. Twenty-three patients (74.2%) had intraoperative confirmation of leak from the middle cranial fossa, involving the temporal bone, while 7 (22.6%) had leaks from the anterior skull base. One patient, who had dural enhancement, had an infratentorial CSF leak along the petrous segment of the internal carotid artery.</p><p><strong>Conclusions: </strong>Our study provides further evidence that skull base and spinal CSF leaks represent distinct pathophysiologies and present with different brain MRI findings.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140890698","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":"Evaluation of an Artificial Intelligence Model for Identification of Mass Effect and Vasogenic Edema on CT of the Head.","authors":"Isabella Newbury-Chaet, Sarah F Mercaldo, John K Chin, Ankita Ghatak, Madeleine A Halle, Ashley L MacDonald, Karen Buch, John Conklin, William A Mehan, Stuart Pomerantz, Sandra Rincon, Keith J Dreyer, Bernardo C Bizzo, James M Hillis","doi":"10.3174/ajnr.A8358","DOIUrl":"10.3174/ajnr.A8358","url":null,"abstract":"<p><strong>Background and purpose: </strong>Mass effect and vasogenic edema are critical findings on CT of the head. This study compared the accuracy of an artificial intelligence model (Annalise Enterprise CTB) with consensus neuroradiologists' interpretations in detecting mass effect and vasogenic edema.</p><p><strong>Materials and methods: </strong>A retrospective stand-alone performance assessment was conducted on data sets of noncontrast CT head cases acquired between 2016 and 2022 for each finding. The cases were obtained from patients 18 years of age or older from 5 hospitals in the United States. The positive cases were selected consecutively on the basis of the original clinical reports using natural language processing and manual confirmation. The negative cases were selected by taking the next negative case acquired from the same CT scanner after positive cases. Each case was interpreted independently by up-to-three neuroradiologists to establish consensus interpretations. Each case was then interpreted by the artificial intelligence model for the presence of the relevant finding. The neuroradiologists were provided with the entire CT study. The artificial intelligence model separately received thin (≤1.5 mm) and/or thick (>1.5 and ≤5 mm) axial series.</p><p><strong>Results: </strong>The 2 cohorts included 818 cases for mass effect and 310 cases for vasogenic edema. The artificial intelligence model identified mass effect with a sensitivity of 96.6% (95% CI, 94.9%-98.2%) and a specificity of 89.8% (95% CI, 84.7%-94.2%) for the thin series, and 95.3% (95% CI, 93.5%-96.8%) and 93.1% (95% CI, 89.1%-96.6%) for the thick series. It identified vasogenic edema with a sensitivity of 90.2% (95% CI, 82.0%-96.7%) and a specificity of 93.5% (95% CI, 88.9%-97.2%) for the thin series, and 90.0% (95% CI, 84.0%-96.0%) and 95.5% (95% CI, 92.5%-98.0%) for the thick series. The corresponding areas under the curve were at least 0.980.</p><p><strong>Conclusions: </strong>The assessed artificial intelligence model accurately identified mass effect and vasogenic edema in this CT data set. It could assist the clinical workflow by prioritizing interpretation of cases with abnormal findings, possibly benefiting patients through earlier identification and subsequent treatment.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141162475","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}