AJNR. American journal of neuroradiology最新文献

{"title":"Prediction of cerebrospinal fluid intervention in fetal ventriculomegaly via AI-powered normative modelling.","authors":"Minerva Zhou, Siddharthasiva A Rajan, Pierre Nedelec, Juana B Bayona, Orit Glenn, Nalin Gupta, Dawn Gano, Elizabeth George, Andreas M Rauschecker","doi":"10.3174/ajnr.A9000","DOIUrl":"https://doi.org/10.3174/ajnr.A9000","url":null,"abstract":"<p><strong>Background and purpose: </strong>Fetal ventriculomegaly (VM) is common and largely benign when isolated. However, it can occasionally progress to hydrocephalus, a more severe condition associated with increased mortality and neurodevelopmental delay that may require surgical postnatal intervention. Accurate differentiation between VM and hydrocephalus is essential but remains challenging, relying on subjective assessment and limited two-dimensional measurements. Deep learning-based segmentation offers a promising solution for objective and reproducible volumetric analysis. This work presents an AI-powered method for segmentation, volume quantification, and classification of the ventricles in fetal brain MRI to predict need for postnatal intervention.</p><p><strong>Materials and methods: </strong>This retrospective study included 222 patients with singleton pregnancies. An nnUNet was trained to segment the fetal ventricles on 20 manually segmented, institutional fetal brain MRIs combined with 80 studies from a publicly available dataset. The validated model was then applied to 138 normal fetal brain MRIs to generate a normative reference range across a range of gestational ages (18-36 weeks). Finally it was applied to 64 fetal brains with VM (14 of which required postnatal intervention). ROC curves and AUC to predict VM and need for postnatal intervention were calculated.</p><p><strong>Results: </strong>The nnUNet predicted segmentation of the fetal ventricles in the reference dataset were high quality and accurate (median Dice score 0.96, IQR 0.93-0.99). A normative reference range of ventricular volumes across gestational ages was developed using automated segmentation volumes. The optimal threshold for identifying VM was 2 standard deviations from normal with sensitivity of 92% and specificity of 93% (AUC 0.97, 95% CI 0.91-0.98). When normalized to intracranial volume, fetal ventricular volume was higher and subarachnoid volume lower among those who required postnatal intervention (p<0.001, p=0.003). The optimal threshold for identifying need for postnatal intervention was 11 standard deviations from normal with sensitivity of 86% and specificity of 100% (AUC 0.97, 95% CI 0.86-1.00).</p><p><strong>Conclusions: </strong>This work introduces a deep-learning based method for fast and accurate quantification of ventricular volumes in fetal brain MRI. A normative reference standard derived using this method can predict VM and need for postnatal CSF intervention. Increased ventricular volume is a strong predictor for postnatal intervention.</p><p><strong>Abbreviations: </strong>VM = ventriculomegaly, 2D = two-dimensional, 3D = three-dimensional, ROC = receiver operating characteristics, AUC = area under curve.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145076898","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":"Nontrauma-Associated Cerebral Fat Embolism Syndrome in Sickle Cell-Related Hemoglobinopathies: A Case Series and Systematic Review.","authors":"Ghazal Shadmani, Helia Hosseini, Zack Nigogosyan, Manu S Goyal, Arash Nazeri","doi":"10.3174/ajnr.A8851","DOIUrl":"https://doi.org/10.3174/ajnr.A8851","url":null,"abstract":"<p><strong>Background: </strong>Cerebral fat embolism (CFE) is frequently associated with long bone fractures and orthopedic procedures but can rarely occur without antecedent trauma. Nontrauma-associated CFE has been reported in patients with sickle cell-related hemoglobinopathies during sickle cell crises, presumably due to bone marrow infarction.</p><p><strong>Purpose: </strong>To characterize the brain MRI features of nontrauma-associated CFE in patients with sickle cell-related hemoglobinopathies during the acute, subacute, and chronic phases after the onset of neurologic symptoms.</p><p><strong>Data source: </strong>This was a combined case series and systematic review of MEDLINE, EMBASE, and Google Scholar databases up to April 2023. This systematic review was not registered with a review registry.</p><p><strong>Study selection: </strong>Patients with sickle cell-related hemoglobinopathies who developed nontrauma-associated CFE were selected based on clinicopathologic evidence and brain MRI findings.</p><p><strong>Data analysis: </strong>Clinical and radiologic data were reviewed.</p><p><strong>Data synthesis: </strong>The systematic review included 26 studies and our 6 unpublished cases, totaling 33 cases of sickle cell-related hemoglobinopathies presenting with nontrauma-associated CFE (91 MRI examinations). Among the patients reviewed, the predominant hemoglobinopathy associated with nontrauma-associated CFE was hemoglobin SC disease (Hb-SC, 61.3%), followed by hemoglobin S/beta-thalassemia (22.6%), and homozygous sickle cell disease (Hb-SS 12.9%). Head CT scans were normal in 77% of the patients. The most frequently observed MRI feature during the acute phase was punctate foci of microhemorrhage (84.7% of cases), which persisted throughout the subacute (91%) and chronic phases (85.8%). The second most common MRI finding during the acute phase was scattered foci of restricted diffusion in a \"starfield pattern\" affecting both cerebral and cerebellar hemispheres (65.4% of cases), which typically was not observable after 5 days.</p><p><strong>Limitations: </strong>The review was based on case reports and small case series, which are subject to reporting bias.</p><p><strong>Conclusions: </strong>Brain imaging features of nontrauma-associated CFE in the setting of sickle cell-related hemoglobinopathies closely resembled those observed in trauma-related CFE. In patients with complex sickle cell-related hemoglobinopathies (Hb-SC and Hb-S/beta-thalassemia) exhibiting unexplained acute neurologic symptoms, radiologists should maintain a high index of suspicion for nontrauma-associated CFE, even with apparently normal initial head CT.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145042426","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":"Lumbar Spine Bone MRI: A Radiation-Free Approach Utilizing CT-Like Imaging for Diagnosing Pars Defects in the Adolescent Spine.","authors":"Franziska C S Altorfer, Jenny J Yan, Frederik Abel, Ellen Casey, Darryl B Sneag, Ek T Tan, Darren R Lebl, J Levi Chazen","doi":"10.3174/ajnr.A8852","DOIUrl":"https://doi.org/10.3174/ajnr.A8852","url":null,"abstract":"<p><strong>Background and purpose: </strong>This is a retrospective cohort study to assess the quality of a synthetic bone MRI protocol by using the spoiled GRE (SPGRE) sequence and determine its usability in detecting pars defects in adolescent patients for orthopedic surgeons and radiologists.</p><p><strong>Materials and methods: </strong>This retrospective study included 30 adolescent patients with lumbar spondylolysis and low back pain. Patients underwent a clinical lumbar spine MRI at 3T that included a 3D SPGRE sequence; 5 patients also underwent a CT for comparison. An orthopedic spine surgeon and an attending radiologist analyzed inverted SGPR and CT images, assessing the presence of a lumbar pars defect and image quality using a 5-point Likert scale. The interreader agreement was calculated.</p><p><strong>Results: </strong>Thirty patients were identified with pars defects seen in all patients on the SPGRE MRI. Image quality scores on a 5-point Likert scale measured an overall average of 4.53 ± 0.60, corresponding to good to perfect image quality, with a substantial interrater agreement with a Gwet AC2 of 0.79 [0.71, 0.88], without significant difference between the orthopedic surgeon and the radiologist (orthopedic surgeon's score 4.50 ± 0.63, radiologist's score 4.53 ± 0.57; <i>P</i> = .91).</p><p><strong>Conclusions: </strong>A synthetic bone MRI protocol using SPGRE is a viable, nonionizing alternative to CT for visualizing pars defects in adolescent patients, providing sufficient image quality for radiologists and orthopedic surgeons.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145042492","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":"Adoption of the T2-FLAIR Mismatch Sign Among Radiologists: How Well Are We Doing?","authors":"F Eymen Ucisik, Shekhar Khanpara, Burak Berksu Ozkara, Ziyi Li, Rasha Alfattal, Samir A Dagher, Max Wintermark, Gregory N Fuller","doi":"10.3174/ajnr.A8783","DOIUrl":"10.3174/ajnr.A8783","url":null,"abstract":"<p><strong>Background and purpose: </strong>The classic T2-FLAIR mismatch sign is a highly specific MRI feature that can aid in preoperative diagnosis of isocitrate dehydrogenase (IDH)-mutant 1p/19q noncodeleted gliomas and affect surgical planning. This study aimed to assess the real-world utilization of the T2-FLAIR mismatch sign in clinical practice, and to explore the frequencies of classic- and partial T2-FLAIR mismatch within the IDH-mutant 1p/19q noncodeleted glioma population stratified by tumor grade.</p><p><strong>Materials and methods: </strong>This retrospective cohort study from a dedicated cancer referral center included 251 patients with IDH-mutant astrocytoma diagnosed between 2017 and 2022. Pathology reports were reviewed for eligibility for the World Health Organization (WHO) 2021 diagnostic criteria. Preoperative MR imaging studies were analyzed by 2 neuroradiologists for the mismatch and enhancement status. MRI reports were assessed for mismatch status reporting frequency, and neuroradiology fellowship status of the dictating radiologist.</p><p><strong>Results: </strong>Two hundred eighty-six preoperative MRIs (212 from outside facilities and 74 in-house) were available from 251 patients with 251 tumors. Of these, 22.3% exhibited classic T2-FLAIR mismatch, 29.8% partial mismatch, and 47.8% no mismatch. Mismatch status significantly differed between WHO grades 2 and 4, but not between grades 2 and 3. Male sex was significantly associated with higher grade. Radiologist reporting rates for the classic mismatch sign were low overall (21.6%), but higher for the dedicated cancer center category (43.3%) compared with other hospital categories (0%-10.3%). The reporting rate was also significantly higher for radiologists with neuroradiology fellowship training compared with those without (25.0% versus 0.0%). A statistically significant upward trend in the reporting rate was observed over the years.</p><p><strong>Conclusions: </strong>The T2-FLAIR mismatch sign is underutilized, particularly in institutions that are not specialized cancer centers. Raising awareness of the T2-FLAIR mismatch sign could enhance preoperative diagnosis of IDH-mutant astrocytoma. Additionally, while the classic mismatch sign is more common in lower-grade IDH-mutant gliomas, it remains relevant in higher-grade tumors.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143994095","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":"Histopathologic Analysis of 5 Patients with CSF-Venous Fistulas after Surgical Nerve Root Ligation and Resection.","authors":"Andrew V Mecum, B K Kleinschmidt-DeMasters, Debayan Bhaumik, Samantha L Pisani Petrucci, Peter J Lennarson, Andrew L Callen","doi":"10.3174/ajnr.A8782","DOIUrl":"10.3174/ajnr.A8782","url":null,"abstract":"<p><p>CSF-venous fistulas (CVFs) are recognized as the most common cause of spontaneous intracranial hypotension, however, exactly how and why CVFs form remains unclear. To better elucidate CVF pathophysiology, histopathologic analysis was performed in 5 patients with CVFs who underwent operative ligation and removal of the implicated nerve root. There were no archetypal findings seen uniformly in all 5 cases, and no definitive CSF-venous connections were visualized. However, all cases manifested variable vascular abnormalities. These included dystrophic mineralization in venous walls, focal venous wall thinning, thrombosis, and hemosiderin deposition. Collectively, these findings suggest venous alterations are associated with CVFs, though causality cannot be determined.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144048446","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 Effect of Prenatal Marijuana Exposure on White Matter Microstructure and Cortical Morphology during Late Childhood.","authors":"Hector Acosta-Rodriguez, Pratheek Bobba, Tal Zeevi, Laura R Ment, Seyedmehdi Payabvash","doi":"10.3174/ajnr.A8774","DOIUrl":"10.3174/ajnr.A8774","url":null,"abstract":"<p><strong>Background and purpose: </strong>Marijuana consumption by pregnant women has been steadily increasing during the past decades. Even though many pregnant women perceive marijuana consumption as safe during pregnancy, it has been previously linked to poor maternal and neonatal outcomes. The specific long-lasting neurodevelopmental alterations caused by prenatal marijuana exposure in children are still underexplored. Thus, this study aimed to determine the effect of prenatal marijuana exposure on brain neurodevelopment in late childhood.</p><p><strong>Materials and methods: </strong>This cross-sectional study investigated the relationship between prenatal marijuana exposure and neuroimaging markers of brain health. Data were obtained from the Adolescent Brain Cognitive Development study, a large, demographically diverse, multicenter cohort. The study included 1085 children, 418 of whom were prenatally exposed to marijuana and 667 matched controls with no prenatal exposure, with a mean age of 9.9 (SD, 0.6) years in both groups.</p><p><strong>Results: </strong>We found that prenatal exposure to marijuana is associated with brain alterations in white matter tracts and cortical regions essential for goal-directed behaviors, including motivation, cognitive skills for achieving specific objectives, and emotional processing. Direct group comparisons revealed significantly reduced WM integrity in prenatally exposed children, with an overall reduction in fractional anisotropy and neurite density and higher mean diffusivity and radial diffusivity. Furthermore, mixed linear model regressions revealed that prenatal marijuana exposure was significantly associated with decreased WM microstructure, predominantly in the superior corticostriate tract and corticostriate projections via the external capsule to the superior parietal and frontal cortices and with reduced cortical surface area in the left hemisphere parahippocampal and right hemisphere postcentral gyri.</p><p><strong>Conclusions: </strong>Overall, our findings suggest that prenatal exposure to marijuana may result in long-lasting alterations in children's brain neurodevelopment. These alterations may impair critical skills needed as children grow into adolescence.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143805178","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":"Middle Meningeal Artery Embolization for Nonacute Subdural Hematoma: A Meta-Analysis of Large Randomized Controlled Trials.","authors":"Huanwen Chen, Matthew K McIntyre, Peter Kan, Dheeraj Gandhi, Marco Colasurdo","doi":"10.3174/ajnr.A8781","DOIUrl":"10.3174/ajnr.A8781","url":null,"abstract":"<p><strong>Background: </strong>Middle meningeal artery embolization (MMAE) has emerged as a novel treatment for non-acute subdural hematoma (SDH), particularly for reducing the risk of SDH recurrence. Recently, 5 randomized controlled trials (RCTs) of MMAE as an adjunct to conventional management (surgical or observant) have concluded their investigation and reported their outcomes.</p><p><strong>Purpose: </strong>Our goal was to synthesize trial results to provide more definitive guidance on the role of MMAE in the management of non-acute SDH.</p><p><strong>Data sources: </strong>The MEDLINE database from inception up to November 23, 2024 was used. English-language clinical articles reporting large randomized controlled trials (<i>n</i> = 100 or more) investigating the efficacy and safety of MMAE for patients with non-acute subdural hematoma were identified.</p><p><strong>Study selection: </strong>Five trials were identified-EMBOLISE, STEM, MAGIC-MT, EMPROTECT, and MEMBRANE.</p><p><strong>Data analysis: </strong>The primary efficacy end point was SDH treatment failure (broadly defined as SDH recurrence or requirement of surgical rescue) within 3 to 6 months. Safety end points include death and stroke.</p><p><strong>Data synthesis: </strong>There was significant heterogeneity in terms of patient populations as well as reported outcomes. Overall, MMAE was associated with significantly lower odds of SDH treatment failure (OR 0.51 [95% CI 0.39-0.67], <i>P</i> < .001), with minimal inter study heterogeneity. Compared with conventional management, MMAE was not significantly associated with different odds of death (OR 1.03 [95% CI 0.36-2.99], <i>P</i> = .95) or stroke (OR 1.10 [95% CI 0.36-3.39], <i>P</i> = .86).</p><p><strong>Limitations: </strong>Our meta-analysis is limited by selection bias and high heterogeneity in study design and reported outcomes.</p><p><strong>Conclusions: </strong>This study provides high-level evidence that, for patients with non-acute SDH, MMAE is a safe and effective adjunct to conventional management for preventing treatment failure.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144033773","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":"Low-Level Light Therapy Effect on Metabolites measured by Magnetic Resonance Spectroscopy in Patients with Moderate Traumatic Brain Injury: A Double-blind, Randomized, Placebo-controlled Clinical Trial.","authors":"Eva-Maria Ratai, Michael R Wenke, Nathaniel Mercaldo, Suk-Tak Chan, Maria G Figueiro Longo, Jonathan Welt, Arman Avesta, Jarone Lee, Michael H Lev, Blair A Parry, Lynn Drake, Richard R Anderson, Terry Rauch, Ramon Diaz-Arrastia, Michael R Hamblin, Benjamin J Vakoc, Rajiv Gupta","doi":"10.3174/ajnr.A8996","DOIUrl":"https://doi.org/10.3174/ajnr.A8996","url":null,"abstract":"<p><strong>Background and purpose: </strong>Low-level light therapy (LLLT) has been shown to modulate recovery in patients with traumatic brain injury (TBI). However, the longitudinal impact of LLLT on brain metabolites has not been studied. The purpose of this study was to use magnetic resonance spectroscopic imaging (MRSI) to assess the metabolic response of LLLT in patients with moderate TBI at acute (within 1 week), subacute (2-3 weeks), and late-subacute (3 months) recovery phases.</p><p><strong>Materials and methods: </strong>This is a secondary analysis of a prospective single-site double-blinded sham-controlled study conducted in patients with moderate TBI. Participants were randomized for LLLT and sham treatment. Three Tesla two-dimensional MRSI was acquired. Our focus of investigation was the metabolic change in the corpus callosum (CC) and the changes in myo-inositol/N-acetyl aspartate (mI/NAA), representing the combined effect of elevated neuroinflammation (mI) and decreased neuronal/axonal health (NAA). A linear mixed-effects model was constructed to quantify the association between mI/NAA and treatment, scan, and the interaction between treatment and scan.</p><p><strong>Results: </strong>Thirty-four participants (18 male, age 49±17 (20 to 79); 15 LLLT, 19 sham) were included in the final data set and were scanned at the following timepoints: acute (N=24), subacute (N=27) and late subacute (N=23). The mI/NAA ratio in the CC of the sham-treated participants increased over time. Sham-treated participants revealed a significant increase in mI/NAA from the acute to the late subacute phases (0.19, 95%CI: 0.09, 0.29; p_Holm=0.005). mI/NAA stayed relatively stable in participants undergoing LLLT treatment (all p_Holm>0.64). Consequently, mI/NAA was significantly higher in the sham-treated participants compared to the LLLT-treated participants during the late subacute phase of recovery (-0.31, 95%CI: -0.50, -0.12; p_Holm=0.019).</p><p><strong>Conclusions: </strong>Despite the small sample size, MRSI indicates a metabolic response in participants treated with LLLT compared to those receiving sham treatment. This potentially suggests a neuroprotective and anti-inflammatory effect from the acute administration of LLLT in individuals with moderate TBI.</p><p><strong>Abbreviations: </strong>LLLT＝Low-level light therapy; TBI＝traumatic brain injury; MRSI = magnetic resonance spectroscopic imaging; CC = corpus callosum; mI = in myo-inositol; NAA = N-acetyl aspartate; ATP = adenosine triphosphate; GCS = Glasgow Coma Scale; LASER = Localization by Adiabatic SElective Refocusing.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145031457","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":"Isolated Congenital Middle Ear Malformations: Comparison of preoperative 0.1 mm Ultra-High-Resolution CT and Conventional High-Resolution CT.","authors":"Jingying Guo, Ning Xu, Ruowei Tang, Heyu Ding, Yuhe Liu, Shusheng Gong, Zhenghan Yang, Zhenchang Wang, Pengfei Zhao","doi":"10.3174/ajnr.A8999","DOIUrl":"https://doi.org/10.3174/ajnr.A8999","url":null,"abstract":"<p><strong>Background and purpose: </strong>Isolated congenital middle ear malformation contributes significantly to congenital hearing loss and growth problems. This study aims to compare 0.1 mm isotropic ultra-high-resolution computed tomography and conventional high-resolution computed tomography for assessing isolated congenital middle ear malformation, using surgical exploration as the gold standard.</p><p><strong>Materials and methods: </strong>This single-center retrospective study included patients with surgically confirmed isolated congenital middle ear malformation who underwent ultra-high-resolution CT or high-resolution CT from January 2015 to April 2025. Middle ear abnormalities were identified based on operative outcomes and four subtypes were classified via the Teunissen standard. Two neuroradiologists blinded to surgical outcomes reviewed CT images for ten subtle structural abnormalities and specific subtypes. The comparison of ultra-high-resolution CT and high-resolution CT in terms of inter-observer and intra-observer agreement and detection of structural abnormalities and subtypes of congenital middle ear malformation were analyzed.</p><p><strong>Results: </strong>The ultra-high-resolution CT and high-resolution CT groups included 61 patients (69 ears) and 37 patients (44 ears), respectively. Ultra-high-resolution CT exhibited significantly higher inter-observer and intra-observer agreement and stronger concordance with surgical findings for all 10 abnormalities compared to high-resolution CT. It also showed superior diagnostic sensitivity for congenital middle ear malformation (100.0% vs. 90.9%, P=0.013) and outperformed high-resolution CT in differentiating clinical subtypes (0.774 vs. 0.352, P< 0.001). Ultra-high-resolution CT achieved accuracies exceeding 0.85 in identifying all abnormalities and outperformed high-resolution CT in detecting specific abnormalities including abnormal long process of the incus, lenticular process, abnormal stapes superstructure, stapes footplate fixation, and oval window atresia (P< 0.05).</p><p><strong>Conclusions: </strong>Isotropic 0.1 mm ultra-high-resolution CT significantly outperforms conventional high-resolution CT in diagnosing congenital middle ear malformation, differencing subtypes and detecting subtle abnormalities, supporting its clinical superiority for precise preoperative evaluation.</p><p><strong>Abbreviations: </strong>CMEM= congenital middle ear malformation; HRCT= high-resolution computed tomography; U-HRCT=ultra-highresolution computed tomography; PCD-CT= photon-counting detector CT.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145031448","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":"Application of high-resolution cone-beam computed tomography for evaluation of endothelialization after flow diverter implantation for unruptured intracranial aneurysms.","authors":"Shuailong Shi, Zhike Zhang, Shuhai Long, Ji Ma, Peijie Lu, Yuncai Ran, Shanshan Xie, Jie Yang, Ye Wang, Tengfei Li","doi":"10.3174/ajnr.A8997","DOIUrl":"https://doi.org/10.3174/ajnr.A8997","url":null,"abstract":"<p><strong>Background and purpose: </strong>Although high-resolution cone-beam computed tomography (HR-CBCT) is used for immediate evaluation of stent apposition, studies using this technique to evaluate flow diverter (FD) endothelialization during follow-up are limited. The study aims to investigate the potential of HR-CBCT in assessing FD endothelialization and identify factors influencing poor endothelialization.</p><p><strong>Materials and methods: </strong>The clinical and imaging data of patients with unruptured intracranial aneurysms (UIAs) treated by FDs from March 2019 to October 2023 were retrospectively analyzed. HR-CBCT was used for immediate evaluation of stent apposition, and FD endothelialization at 3-, 6-, and 12-months post-implantation was evaluated using HR-CBCT and digital subtraction angiography. Multivariate logistic regression analysis was used to identify factors associated with poor endothelialization.</p><p><strong>Results: </strong>Among 402 FDs implanted for 446 aneurysms in 378 patients, 41 showed incomplete stent apposition (ISA) in post-implantation HR-CBCT scans. The aneurysm-occlusion rate at 12 months post-implantation was 84.8% (378/446), with 8.7% (35/402) of the FDs exhibiting in-stent stenosis (ISS). At 12 months post-implantation, 343 (85.1%) FDs showed good endothelialization, while 59(14.9%) exhibited poor endothelialization. Multivariate logistic regression analysis identified age ≥ 60 years (OR=2.209;95% CI:1.053-4.635;P=0.04), a large aneurysm lumen inflow angle (OR=1.102;95% CI:1.071-1.135;P<0.001), parent artery excessive tortuosity (OR=9.402;95% CI:1.141-77.479;P=0.04), and ISA (OR=10.967;95% CI:4.290-28.035;P<0.001) as independent risk factors for poor endothelialization.</p><p><strong>Conclusions: </strong>HR-CBCT can accurately evaluate FD endothelialization and ISS of UIAs after FD implantation. Age ≥ 60 years, a large aneurysm lumen inflow angle, parent artery excessive tortuosity, and ISA are independent risk factors for poor endothelialization.</p><p><strong>Abbreviations: </strong>HR-CBCT = high-resolution cone-beam computed tomography; FD = flow diverter; UIAs = unruptured intracranial aneurysms; ISA = incomplete stent apposition; ISS = in-stent stenosis.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145031480","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}