AJNR. American journal of neuroradiology最新文献

{"title":"Comprehensive Review of Inner Ear Anatomy on Photon-Counting CT.","authors":"Dinesh Rao, John V Murray, Amit K Agarwal, Sukhwinder Johnny Sandhu, Pat A Rhyner","doi":"10.3174/ajnr.A8410","DOIUrl":"10.3174/ajnr.A8410","url":null,"abstract":"<p><p>The inner ear contains many fissures and canals that can mimic pathology. Photon-counting CT allows greater spatial and contrast resolution of these structures over traditional energy-integrating CT detectors. Small channels containing nerves, arteries, and normal anatomy such as the cochlear cleft and cochlear and vestibular aqueducts are commonly encountered on temporal bone imaging. The improved visualization of these structures poses challenges for radiologists who are new to photon-counting CT. This article updates the existing temporal bone anatomy literature with a detailed anatomic review of the inner ear and major nerves frequently encountered when reviewing temporal bone imaging.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":"862-867"},"PeriodicalIF":0.0,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12091973/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141592389","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mesenchymal Nonmeningothelial Tumors of the CNS: Evolving Molecular Landscape and Implications for Neuroradiologists.","authors":"Neetu Soni, Manish Ora, Denes Szekeres, Girish Bathla, Amit Desai, Vivek Gupta, Aparna Singhal, Amit Agarwal","doi":"10.3174/ajnr.A8519","DOIUrl":"10.3174/ajnr.A8519","url":null,"abstract":"<p><p>The World Health Organization Classification of Tumors of the Central Nervous System, 5th edition (WHO CNS5) significantly revised the terminology and diagnostic criteria of \"mesenchymal nonmeningothelial\" tumors of CNS to better align with the classification of these soft tissue tumors outside the CNS. The CNS chapter only covers the entities with distinct histologic or molecular characteristics that occur exclusively or primarily in the CNS. These tumors usually arise from the meninges and are rarely intraparenchymal in origin, mainly in the supratentorial compartment. These tumors are grouped into 3 main categories: soft tissue, chondro-osseous, and notochordal. Soft tissue tumors, the largest group, are further divided into fibroblastic, vascular, and skeletal muscle subtypes. Notably, a new subcategory for \"tumors of uncertain differentiation\" has been introduced, encompassing 3 new histomolecular entities: <i>FET::</i>cAMP response element-binding protein (<i>CREB)</i> fusion-positive, Capicua transcriptional receptor (<i>CIC</i>)-rearranged sarcoma, and primary intracranial sarcoma, DICER1-mutant. Emerging entities like dural angioleiomyomas and spindle cell neoplasms with neurotrophic receptor kinase (NTRK) rearrangements have been reviewed, although not introduced in WHO CNS5. Given the often nonspecific histology and immunophenotype of mesenchymal nonmeningothelial tumors of uncertain differentiation, molecular techniques have become indispensable for accurate diagnosis. This review provides a comprehensive overview of primary mesenchymal nonmeningothelial CNS tumors, including their clinical, radiologic, histopathologic, and molecular characteristics and treatment strategies.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":"868-878"},"PeriodicalIF":0.0,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12091988/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142334162","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-Term Outcome of Rescue Stenting for Acute Intracranial Atherosclerotic Stenosis-Related Large Vessel Occlusion in the Anterior Circulation.","authors":"Hyungjong Park, Byung Moon Kim, Jun-Whee Kim, Jin Woo Kim, Jang-Hyun Baek, Dong Joon Kim, Min Jeoung Kim, Sun Yoon, Chang Ki Jang, Sunghan Kim, JoonNyung Heo, Jung-Keun Lee, In Hwan Lim, Ji Hoe Heo, Hyo Suk Nam, Young Dae Kim","doi":"10.3174/ajnr.A8598","DOIUrl":"10.3174/ajnr.A8598","url":null,"abstract":"<p><strong>Background and purpose: </strong>Rescue stent (RS) is an accepted rescue option after failed mechanical thrombectomy (MT) for acute ischemic stroke due to intracranial atherosclerotic stenosis (ICAS)-related large vessel occlusion (LVO). However, the long-term outcomes (≥12 months) of RS have not yet been elucidated.</p><p><strong>Materials and methods: </strong>We retrospectively analyzed the data of 154 patients with RS for ICAS-related LVO, which were identified from a prospectively maintained multicenter database of RS after MT failure, to assess good outcome (mRS 0-2), mortality, stroke recurrence, symptomatic intracranial hemorrhage (SICH), and stent patency.</p><p><strong>Results: </strong>Among 154 patients, successful recanalization was achieved in 132 (85.7%) after RS. Clinical follow-up was available in 148 patients at 3 months, of whom 126 were followed longer than 12 months. Good outcome was observed in 53.4% (79/148) at 3 months and 53.2% (67/126) at the final assessment among survivors (median, 33; interquartile range [IQR], 13-91 months). The overall incidence of mortality was 16.2% (24/148). Mortality occurred in 8.8% (13/148) of patients at 3 months and 8.7% (11/126) thereafter, respectively. Stroke recurrence was 0.7% (1/148) within 3 months and 3.2% (4/126) thereafter. The overall incidence of SICH was 9.5% (14/148). SICH occurred in 8.8% (13/148) within the first 3 months and in 0.8% (1/126) thereafter. The stented vessel was patent in 81.1% (99/122) at the first follow-up (median, 3; IQR, 1-125 months) and 96.7% (89/92) at the final follow-up (median, 18; IQR, 13-68 months).</p><p><strong>Conclusions: </strong>Patients with RS for ICAS-LVO showed a low stroke recurrence rate in the long-term. The long-term patency of RS appears to remain durable, particularly when it remained patent during the initial follow-up.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":"936-942"},"PeriodicalIF":0.0,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12091986/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142694071","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Change in Emergency Department Length of Stay following Routine Adoption of Dual-Energy CT to Differentiate Intracranial Hemorrhage from Calcification.","authors":"Ngoc-Anh Tran, Christopher A Potter, Camden Bay, Aaron D Sodickson","doi":"10.3174/ajnr.A8610","DOIUrl":"10.3174/ajnr.A8610","url":null,"abstract":"<p><strong>Background and purpose: </strong>Dual-energy CT (DECT) is an advanced CT technique that has been shown to improve accuracy in distinguishing between intracranial hemorrhage and calcification, which is often challenging on conventional CT and therefore may warrant repeat imaging in the emergency department (ED) to document stability and exclude enlarging intracranial hemorrhage. We hypothesized that implementation of a DECT head protocol in the ED would decrease the need for repeat imaging and therefore reduce overall ED length of stay (LOS).</p><p><strong>Materials and methods: </strong>This is a retrospective study comparing ED LOS over a 1-year period before (July 1, 2016 to June 30, 2017) and after (July 1, 2018 to June 30, 2019) implementing a DECT head protocol, for patients scanned for headache, trauma, or fall who were found to have indeterminate intracranial hyperdensities on conventional images, and were subsequently discharged home from the ED (excluding patients who were admitted, taken to the operating room, or left against medical advice). Additional clinical information regarding ED time course and management were also reviewed, including data on time to CT scan, CT report, and if applicable, time to repeat head CT and neurosurgical consultation.</p><p><strong>Results: </strong>There was no significant difference in patient demographics and CT indications between the pre-DECT and post-DECT cohorts. There was a small but statistically significant difference in mean baseline ED LOS in the initial cohorts of 20 minutes (<i>P</i> = .002). After the inclusion of only intracranial indeterminate hyperdensities, there was a larger statistically significant difference in ED LOS, with mean pre-DECT LOS of 421 minutes and mean post-DECT LOS of 272 minutes, resulting in mean LOS reduction of 149 minutes (<i>P</i> = .003). The increased ED LOS correlated with increased frequency of neurosurgical consultation and repeat head CT for the findings of indeterminate intracranial hyperdensities.</p><p><strong>Conclusions: </strong>ED LOS was significantly longer in the pre-DECT cohort, which was partly attributable to neurosurgical consultation and repeat head CT performed for indeterminate intracranial hyperdensities.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":"950-955"},"PeriodicalIF":0.0,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12091980/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142856905","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Comparative Study of CT Perfusion Postprocessing Tools in Medium/Distal Vessel Occlusion Stroke.","authors":"Helene Corbaz, Nikolaos Ntoulias, Alex Brehm, Julia Wolleb, Philippe Claude Cattin, Florentin Bieder, Victor Schulze-Zachau, Marios-Nikos Psychogios","doi":"10.3174/ajnr.A8616","DOIUrl":"10.3174/ajnr.A8616","url":null,"abstract":"<p><strong>Background and purpose: </strong>CTP has been validated for stroke due to large vessel occlusion, but not for medium or distal vessel occlusions (MDVO). The aim of this study was to evaluate discrepancy of 2 widely used postprocessing tools for CTP in patients with medium/distal vessel occlusion (MDVO) stroke.</p><p><strong>Materials and methods: </strong>This retrospective single-center cohort study comprised CTP data sets of patients with acute isolated MDVO and disabling stroke. CTP postprocessing included Syngo.via and RapidAI. Perfusion lesions were segmented and compared with regard to volume and spatial distribution of the perfusion abnormalities. For each patient, the results of the 2 postprocessing tools were deemed to represent agreement regarding volume and/or distribution according to a predefined classification scheme. Penumbra volumes were compared between postprocessing tools by using the <i>t</i> test for paired samples.</p><p><strong>Results: </strong>Fifty CTP data sets from 49 patients (mean age 75.3 ± 10.7 years, 33 male patients) were included. In <30% of patients, the predefined criteria for agreement were met which indicate at least 50% congruence regarding lesion size and lesion location as well as a maximum distance between lesion margins <50 mm. Comparison of tissue at risk volumes revealed outliers, volume disagreement, and distribution disagreement in up to 79.6%. The 2 postprocessing tools disagreed on presence and volume of an infarct core in up to 86% of patients. Penumbra volumes differed significantly between postprocessing tools (<i>P</i> < .001; mean difference 50.5 mL/16.9 mL).</p><p><strong>Conclusions: </strong>Despite being in daily use, commercially available postprocessing tools for CTP provide discrepant results in patients with MDVO.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":"46 5","pages":"900-907"},"PeriodicalIF":0.0,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12091985/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144058754","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Inner Ear Signal Abnormalities of Adjacent Intracranial Lipochoristoma.","authors":"John C Benson, Matthew L Carlson, Karl R Khandalavala, Girish Bathla, Paul J Farnsworth, Jamie J Van Gompel, John T Wald, John I Lane","doi":"10.3174/ajnr.A8603","DOIUrl":"10.3174/ajnr.A8603","url":null,"abstract":"<p><strong>Background and purpose: </strong>Inner ear signal abnormalities commonly develop in cases of vestibular schwannoma and are associated with hearing loss. Whether such signal alterations occur in other masses of the internal auditory canal (IAC), however, remains unknown. Here, we assessed inner ear signal abnormalities of lipochoristomas, historically termed \"lipomas,\" involving the IAC and cerebellopontine angle (CPA).</p><p><strong>Materials and methods: </strong>A retrospective review was completed of patients with an MRI of an IAC and/or CPA intracranial lipochoristoma. The signal intensity of the ipsilateral labyrinthine structures was both subjectively and objectively compared with the contralateral side on FLAIR, FSE, T2 sampling perfection with application-optimized contrasts by using different flip angle evolution (SPACE sequence) and gradient recalled-echo (CISS) images by 2 neuroradiologists. Any initial disagreements were resolved by joint review to establish a consensus.</p><p><strong>Results: </strong>Fourteen patients were included. The average age was 53.1 (SD, 11.7) years, and 6 patients (42.9%) were women. Twelve of 14 (86%) of the lipochoristomas were in the IAC; the remaining masses were in the CPA. Regarding subjective assessment of abnormal labyrinthine signal, there was perfect interobserver agreement using FLAIR and T2 SPACE images; the Fleiss κ for CISS images was 0.7379. After consensus review, abnormal signal was noted in the adjacent labyrinthine structures in most cases on FLAIR (75%) and T2 CISS (73%); only 8% of patients had abnormal signal on T2 SPACE. Objective measurements of the cochlear signal similarly demonstrated relatively increased ipsilateral signal on FLAIR (<i>P</i> = .011) and relatively decreased signal on T2 CISS (<i>P</i> = .046). No significant difference was noted between ipsilateral and contralateral measurements on T2 SPACE (<i>P</i> = .093).</p><p><strong>Conclusions: </strong>Abnormally increased FLAIR signal and decreased T2 CISS signal are present in most ipsilateral labyrinthine structures in patients with IAC and/or CPA lipochoristomas. Thus, these labyrinthine signal alterations are not exclusively restricted to vestibular schwannomas.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":"46 5","pages":"1016-1021"},"PeriodicalIF":0.0,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12091978/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144044531","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Automated Quantification of Cerebral Microbleeds in SWI: Association with Vascular Risk Factors, White Matter Hyperintensity Burden, and Cognitive Function.","authors":"Ji Su Ko, Yangsean Choi, Eun Seon Jeong, Hyun-Jung Kim, Grace Yoojin Lee, Ji Eun Park, Namkug Kim, Ho Sung Kim","doi":"10.3174/ajnr.A8552","DOIUrl":"10.3174/ajnr.A8552","url":null,"abstract":"<p><strong>Background and purpose: </strong>The amount and distribution of cerebral microbleeds (CMB) are important risk factors for cognitive impairment. Our objective was to train and validate a deep learning (DL)-based segmentation model for cerebral microbleeds (CMBs) on SWI and to find associations among CMB, cognitive impairment, and vascular risk factors.</p><p><strong>Materials and methods: </strong>Participants in this single-institution retrospective study underwent brain MRI to evaluate cognitive impairment between January and September 2023. For training the DL model, the nnU-Net framework was used without modifications. The performance of the DL model was evaluated on independent internal and external validation data sets. Linear regression analysis was used to find associations among log-transformed CMB numbers, cognitive function (Mini-Mental Status Examination [MMSE]), white matter hyperintensity (WMH) burden, and clinical vascular risk factors (age, sex, hypertension, diabetes, lipid profiles, and body mass index).</p><p><strong>Results: </strong>Training of the DL model (<i>n</i> = 287) resulted in a robust segmentation performance with an average Dice score of 0.73 (95% CI, 0.67-0.79) in an internal validation set (<i>n</i> = 67) and modest performance in an external validation set (Dice score = 0.46; 95% CI, 0.33-0.59; <i>n</i> = 68). In a temporally independent clinical data set (<i>n</i> = 448), older age, hypertension, and WMH burden were significantly associated with CMB numbers in all distributions (total, lobar, deep, and cerebellar; all <i>P </i>< .<i> </i>01). The MMSE was significantly associated with hyperlipidemia (β = 1.88; 95% CI, 0.96-2.81; <i>P </i>< .<i> </i>001), WMH burden (β = -0.17 per 1% WMH burden, 95% CI, -0.27-0.08; <i>P</i> < . 001), and total CMB number (β = -0.01 per 1 CMB, 95% CI, -0.02-0.001; <i>P</i> = .04) after adjusting for age and sex.</p><p><strong>Conclusions: </strong>The DL model showed a robust segmentation performance for CMB. In all distributions, CMB had significant positive associations with WMH burden. Increased WMH burden and CMB numbers were associated with decreased cognitive function.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":"1007-1015"},"PeriodicalIF":0.0,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12091992/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142514456","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Repeatability and Reproducibility of Pseudocontinuous Arterial Spin-Labeling-Measured Brain Perfusion in Healthy Volunteers and Patients with Glioblastoma.","authors":"Limin Zhou, Durga Udayakumar, Yiming Wang, Marco C Pinho, Benjamin C Wagner, Michael Youssef, Joseph A Maldjian, Ananth J Madhuranthakam","doi":"10.3174/ajnr.A8551","DOIUrl":"10.3174/ajnr.A8551","url":null,"abstract":"<p><strong>Background and purpose: </strong>Arterial spin-labeling (ASL) MRI has gained recognition as a quantitative perfusion imaging method for managing patients with brain tumors. Limited studies have so far investigated the reproducibility of ASL-derived perfusion in these patients. This study aimed to evaluate intrasession repeatability and intersession reproducibility of perfusion measurements using 3D pseudocontinuous ASL (pCASL) with TSE Cartesian acquisition with spiral profile reordering (TSE-CASPR) in healthy volunteers (HV) and patients with glioblastoma (GBM) at 3T and to compare them against 3D pCASL with gradient and spin echo (GRASE).</p><p><strong>Materials and methods: </strong>This prospective study (NCT03922984) was approved by the institutional review board, and written informed consent was obtained from all subjects. HV underwent repeat pCASL evaluations 2-4 weeks apart between November 2021 and October 2022. Patients with GBM were recruited for longitudinal MRI from September 2019 to February 2023. Intrasession repeatability (HV and GBM) and intersession reproducibility (HV only) of pCASL were assessed using linear regression, Bland-Altman analyses, the intraclass correlation coefficient (ICC) with 95% CI, and within-subject coefficients of variation (wsCV).</p><p><strong>Results: </strong>Twenty HV (9 men; mean age, 25.1 [SD, 1.7] years; range, 23-30 years) and 21 patients with GBM (15 men; mean age, 59.8 [SD, 14.3] years; range, 28-81 years) were enrolled. In imaging sessions, 3D pCASL-measured perfusion with TSE-CASPR and GRASE, respectively, achieved high <i>R</i> ² values (0.88-0.95; 0.93-0.96), minimal biases (-0.46-0.81; -0.08-0.35 mL/100 g/min), high ICCs [95% CI], 0.96-0.98 [0.94-0.98]; 0.96-0.98 [0.92-0.99]), and low wsCV (6.64%-9.07%; 5.20%-8.16%) in HV (<i>n</i> = 20) and patients with GBM (<i>n</i> = 21). Across imaging sessions, 3D pCASL in HV (<i>n</i> = 20) achieved high <i>R</i> ² values (0.71; 0.82), minimal biases (-1.2; -0.90 mL/100 g/min), high ICC [95% CI] values (0.85 [0.81-0.89]; 0.90 [0.87-0.93]), and low wsCV values (13.82%; 9.98%).</p><p><strong>Conclusions: </strong>Our study demonstrated excellent intrasession repeatability of 3D pCASL-measured cerebral perfusion in HV and patients with GBM and good-to-excellent intersession reproducibility in HV. 3D pCASL with GRASE performed slightly better than 3D pCASL with TSE-CASPR in HV; however, in patients with GBM, 3D pCASL with TSE-CASPR showed better performance in tumor regions with a nearly 2-fold higher SNR. ASL-measured perfusion could serve as a noncontrast quantitative imaging biomarker to facilitate the management of patients with GBM.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":"973-982"},"PeriodicalIF":0.0,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12091990/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142514458","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Stroke Thrombectomy for Large Infarcts with Limited Penumbra: Systematic Review and Meta-Analysis of Randomized Trials.","authors":"Huanwen Chen, Seemant Chaturvedi, Dheeraj Gandhi, Marco Colasurdo","doi":"10.3174/ajnr.A8553","DOIUrl":"10.3174/ajnr.A8553","url":null,"abstract":"<p><strong>Background: </strong>Recent randomized trials have suggested that endovascular thrombectomy (EVT) is superior to medical management (MM) for stroke patients with large infarcts. However, whether or how perfusion metrics should be used to guide optimal patient selection for treatment is unknown.</p><p><strong>Purpose: </strong>To synthesize trial results to provide more definitive guidance on the role of EVT for stroke patients with large infarcts based on perfusion metrics.</p><p><strong>Data sources: </strong>MEDLINE database from inception up to July 8, 2024. Randomized controlled trials that report the efficacy and safety of EVT for patients with large infarcts (defined by either infarct core volume greater than 50cc or Alberta Stroke Program Early CT Score [ASPECTS] less than 6) stratified by mismatch profile were included.</p><p><strong>Study selection: </strong>Five trials were identified - SELECT2 and ANGEL-ASPECT.</p><p><strong>Data analysis: </strong>The primary outcome was odds of acceptable outcomes (90-day modified Rankin scale [mRS] 0 to 3). Secondary outcome was 90-day mRS 5 or 6. Patients where then subdivided into those with mismatch ratio 1.2-1.8 or penumbra volume 10-15cc (intermediate mismatch) and those with mismatch ratio <1.2 or volume <10cc (low mismatch).</p><p><strong>Data synthesis: </strong>A total of 140 intermediate mismatch (75 EVT and 65 MM) and 60 low mismatch patients (23 EVT and 37 MM) were identified. EVT was significantly associated with higher odds of mRS 0-3 for intermediate mismatch (OR 2.77 [95% CI 1.11-6.89], <i>P</i> = .028), but not low mismatch (OR 1.47 [95% CI 0.44-4.94], <i>P</i> = .54). Similarly, in terms of 90-day poor outcomes (mRS 5-6), EVT for intermediate mismatch patients was significantly associated with lower odds (OR 0.49 [95% CI 0.24 to 0.99], <i>P</i> = .046), while EVT for the low mismatch cohort was not (OR 0.66 [95% CI 0.22 to 1.96], <i>P</i> = .45). There was no significant inter-study heterogeneity observed across study estimates.</p><p><strong>Conclusions: </strong>For stroke patients with large infarcts, EVT was beneficial for patients with perfusion mismatch ratio and volume of at least 1.2 and 10cc, but not for those with mismatch ratio <1.2 or volume <10cc.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":"915-920"},"PeriodicalIF":0.0,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12091987/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142514459","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic Performance of Fast Brain MRI Compared with Routine Clinical MRI in Patients with Glioma Grades 3 and 4: A Pilot Study.","authors":"Francesca De Luca, Annika Suneson, Annika Kits, Emilia Palmér, Stefan Skare, Anna Falk Delgado","doi":"10.3174/ajnr.A8558","DOIUrl":"10.3174/ajnr.A8558","url":null,"abstract":"<p><strong>Background and purpose: </strong>EPIMix is a fast brain MRI technique not previously investigated in patients with grade 3 and 4 gliomas. This pilot study aimed to investigate the diagnostic performance of EPIMix in the radiological treatment evaluation of adult patients with grade 3 and 4 gliomas compared with routine clinical MRI (rcMRI).</p><p><strong>Materials and methods: </strong>Patients with grade 3 and 4 gliomas investigated with rcMRI and EPIMix were retrospectively included in the study. Three readers (R1-R3) participated in the radiological assessment applying the Response Assessment for Neuro-Oncology (RANO 2.0) criteria, of whom two (R1 and R2) independently evaluated EPIMix and later rcMRI by measuring contrast-enhancing and non-contrast-enhancing tumor regions at each follow-up. For cases with discrepant evaluations, an unblinded side-by-side (EPIMix and rcMRI) reading was performed together with a third reader (R3). Comparisons between methods (EPIMix versus rcMRI) were performed using the weighted Cohen κ. The sensitivity and specificity to progressive disease (PD) on a follow-up scan were calculated for EPIMix compared with rcMRI with receiver operating characteristic curves (ROC) to assess the area under the curve (AUC).</p><p><strong>Results: </strong>Of 35 patients (mean age, 53 years; 31% women), a total of 93 MRIs encompassing 58 follow-up investigations showed PD at a blinded reading in 33% of EPIMix (19/58, R1-2), while in 31% (18/58 exams, R1), and 34% (20/58 exams, R2) of rcMRI. An almost perfect agreement for tumor category assessment was found between EPIMix and rcMRI (EPIMixR1 versus rcMRIR1 κ = 0.96; EPIMixR2 versus rcMRIR2 κ = 0.89). The sensitivity for EPIMix to detect PD was 1.00 (0.81-1.00) for R1 and 0.90 (0.68-0.99) for R2, while the specificity was 0.97 (0.86-1.00) for R1 and R2. The AUC for PD was 0.99 for R1 (EPIMixR1 versus rcMRIR1) and 0.94 for R2 (EPIMixR2 versus rcMRIR2). The <i>P</i> value of the DeLong test AUCR1 versus AUCR2 was <i>P</i> = .20 (R1-R2).</p><p><strong>Conclusions: </strong>In this pilot study, EPIMix was used as a fast MRI alternative for treatment evaluation of patients with glioma grades 3 and 4, with high but slightly lower diagnostic performance than rcMRI.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":"983-989"},"PeriodicalIF":0.0,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12091972/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142549478","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}