AJNR. American journal of neuroradiology最新文献

{"title":"Technical Tips for CT-Guided Fibrin Glue Patching of CSF-Venous Fistulas.","authors":"Mark D Mamlouk","doi":"10.3174/ajnr.A8679","DOIUrl":"https://doi.org/10.3174/ajnr.A8679","url":null,"abstract":"<p><p>Fibrin glue patching can be an effective treatment for CSF-venous fistulas, along with transvenous embolization and surgical ligation.^1,2 The technique differs from routine epidural patching, which is typically targeted in the dorsal or ventral epidural spaces. Instead, fibrin glue patching for CSF-venous fistulas is specifically targeted to the venous drainage pattern.³ There are 3 main locations to target: 1) the cyst-vein junction, 2) paravertebral \"wall,\" and 3) direct cyst puncture, and the goal is to sever the connection between the cyst and vein. In this video, technical tips for successful patching will be illustrated for these target locations.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":"46 3","pages":"597"},"PeriodicalIF":0.0,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143559742","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":"Imaging Findings in Giant Cell Arteritis: Don't Turn a Blind Eye to the Obvious!","authors":"Girish Bathla, Amit K Agarwal, Steven A Messina, David F Black, Neetu Soni, Felix E Diehn, Norbert G Campeau, Vance T Lehman, Kenneth J Warrington, Rennie L Rhee, Thorsten A Bley","doi":"10.3174/ajnr.A8388","DOIUrl":"10.3174/ajnr.A8388","url":null,"abstract":"<p><p>Giant cell arteritis (GCA) is the most common primary large vessel systemic vasculitis in the Western World. Even though the involvement of scalp and intracranial vessels has received much attention in the neuroradiology literature, GCA, being a systemic vasculitis, can involve multiple other larger vessels including the aorta and its major head and neck branches. Herein, the authors present a pictorial review of the various cranial, extracranial, and orbital manifestations of GCA. An increased awareness of this entity may help with timely and accurate diagnosis, helping expedite therapy and preventing serious complications.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":"457-464"},"PeriodicalIF":0.0,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141437870","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":"Comprehensive Review of the Utility of Dynamic Contrast-Enhanced MRI for the Diagnosis and Treatment Assessment of Spinal Benign and Malignant Osseous Disease.","authors":"Atin Saha, Haley Gibbs, Kyung K Peck, Onur Yildirim, Parsa Nilchian, Sasan Karimi, Eric Lis, Vilma Kosović, Andrei I Holodny","doi":"10.3174/ajnr.A8398","DOIUrl":"10.3174/ajnr.A8398","url":null,"abstract":"<p><p>Conventional MRI is currently the preferred imaging technique for detection and evaluation of malignant spinal lesions. However, this technique is limited in its ability to assess tumor viability. Unlike conventional MRI, dynamic contrast-enhanced (DCE) MRI provides insight into the physiologic and hemodynamic characteristics of malignant spinal tumors and has been utilized in different types of spinal diseases. DCE has been shown to be especially useful in the cancer setting; specifically, DCE can discriminate between malignant and benign vertebral compression fractures as well as between atypical hemangiomas and metastases. DCE has also been shown to differentiate between different types of metastases. Furthermore, DCE can be useful in the assessment of radiation therapy for spinal metastases, including the prediction of tumor recurrence. This review considers data analysis methods utilized in prior studies of DCE-MRI data acquisition and clinical implications.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":"465-475"},"PeriodicalIF":0.0,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142559690","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":"AI-Generated Synthetic STIR of the Lumbar Spine from T1 and T2 MRI Sequences Trained with Open-Source Algorithms.","authors":"Alice M L Santilli, Mark A Fontana, Erwin E Xia, Zenas Igbinoba, Ek Tsoon Tan, Darryl B Sneag, J Levi Chazen","doi":"10.3174/ajnr.A8512","DOIUrl":"10.3174/ajnr.A8512","url":null,"abstract":"<p><strong>Background and purpose: </strong>Lumbar spine MRIs can be time consuming, stressful for patients, and costly to acquire. In this work, we train and evaluate open-source generative adversarial network (GAN) to create synthetic lumbar spine MRI STIR volumes from T1 and T2 sequences, providing a proof-of-concept that could allow for faster MRI examinations.</p><p><strong>Materials and methods: </strong>A total of 1817 MRI examinations with sagittal T1, T2, and STIR sequences were accumulated and randomly divided into training, validation, and test sets. A GAN was trained to create synthetic STIR volumes by using the T1 and T2 volumes as inputs, optimized with the validation set, and then applied to the test set. Acquired and synthetic test set volumes were independently evaluated in a blinded, randomized fashion by 3 radiologists specializing in musculoskeletal imaging and neuroradiology. Readers assessed image quality, motion artifacts, perceived likelihood of the volume being acquired or synthetic, and the presence of 7 pathologies.</p><p><strong>Results: </strong>The optimal model leveraged a customized loss function that accentuated foreground pixels, achieving a structural similarity imaging metric of 0.842, mean absolute error of 0.028, and peak signal-to-noise ratio of 26.367. Radiologists could distinguish synthetic from acquired volumes; however, the synthetic volumes were of equal or better quality in 77% of test patients and demonstrated equivalent or decreased motion artifacts in 78% of test patients. For common pathologies, the synthetic volumes had high positive predictive value (75%-100%) but lower sensitivity (0%-67%).</p><p><strong>Conclusions: </strong>This work links objective computer vision performance metrics and subject clinical evaluation of synthetic spine MRIs by using open-source and reproducible methodologies. High-quality synthetic volumes are generated, reproducing many important pathologies and demonstrating a potential means for expediting imaging protocols.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":"552-558"},"PeriodicalIF":0.0,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142980990","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":"Erratum.","authors":"","doi":"10.3174/ajnr.A8666","DOIUrl":"https://doi.org/10.3174/ajnr.A8666","url":null,"abstract":"","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":"46 3","pages":"644"},"PeriodicalIF":0.0,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143559364","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":"Imaging of the Hyrtl Fissure: A Rare Cause of Congenital CSF Otorrhea.","authors":"Jamie E Clarke, John Manov, Josephine M Ndolo, Tangayi Githu, Khushi Saigal, Gaurav Saigal","doi":"10.3174/ajnr.A8525","DOIUrl":"10.3174/ajnr.A8525","url":null,"abstract":"<p><p>Hyrtl fissure is a rare cause of congenital CSF otorrhea in infants, with only a few cases previously described in the English literature. Given the predisposition to repeated ear and intracranial infections, identification of this bony anomaly is critical in the diagnosis and management of recurrent meningitis or otitis media in a child, especially in the presence of CSF otorrhea. We describe 3 cases of this entity with a specific focus on the embryologic basis of the etiology and conventional and advanced imaging features of this unique entity.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":"580-582"},"PeriodicalIF":0.0,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143525462","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":"Hypoperfusion Intensity Ratio Less Than 0.4 Is Associated with Favorable Outcomes in Unsuccessfully Reperfused Acute Ischemic Stroke with Large-Vessel Occlusion.","authors":"Vivek Yedavalli, Hamza Adel Salim, Aneri Balar, Dhairya A Lakhani, Janet Mei, Hanzhang Lu, Licia Luna, Francis Deng, Vaibhav Vagal, Nathan Z Hyson, Jens Fiehler, Paul Stracke, Gabriel Broocks, Christian Heitkamp, Gregory W Albers, Max Wintermark, Tobias D Faizy, Jeremy J Heit","doi":"10.3174/ajnr.A8518","DOIUrl":"10.3174/ajnr.A8518","url":null,"abstract":"<p><strong>Background and purpose: </strong>Endovascular thrombectomy is a standard treatment for acute ischemic stroke due to large-vessel occlusions (AIS-LVO), but a large minority of patients do not achieve successful reperfusion. This study aimed to investigate the hypoperfusion intensity ratio (HIR) as a prognostic biomarker in unsuccessfully reperfused patients with AIS-LVO.</p><p><strong>Materials and methods: </strong>A multicenter retrospective cohort study was conducted at 2 comprehensive stroke centers, involving patients with AIS-LVO who underwent endovascular thrombectomy but did not achieve successful reperfusion, defined as a modified TICI score of 0-2a. HIR, derived from CT or MR perfusion imaging, was analyzed for its association with favorable clinical outcomes (90-day mRs score of 0-2). The optimal HIR threshold predictive of favorable outcomes was identified through receiver operating curve analysis.</p><p><strong>Results: </strong>Of 129 patients included, 20 (15.5%) achieved favorable outcomes. HIR of <0.4 significantly predicted favorable outcomes with a sensitivity of 66% and specificity of 80%. Patients with an HIR of <0.4 demonstrated better clinical and imaging profiles, including lower admission NIHSS scores and smaller ischemic core volumes. Multivariable logistic regression confirmed HIR, along with age and the presence of hemorrhagic transformation, as independent predictors of favorable outcomes.</p><p><strong>Conclusions: </strong>In unsuccessfully reperfused patients with AIS-LVO, an HIR of <0.4 is associated with favorable outcomes, emphasizing on the importance of robust collateral circulation. This finding suggests that perfusion imaging and HIR evaluation could guide clinical decision-making and prognostication in this challenging patient subset.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":"483-488"},"PeriodicalIF":0.0,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143469917","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Volumetric Changes of the Choroid Plexus before and after Spinal CSF Leak Repair.","authors":"Karen Buch, Aaron Paul, Neo Poyiadji, William A Mehan","doi":"10.3174/ajnr.A8514","DOIUrl":"10.3174/ajnr.A8514","url":null,"abstract":"<p><strong>Background and purpose: </strong>Patients with intracranial hypotension from spinal CSF leaks have increased choroid plexus volumes in response to CSF leakage. The purpose of this study was to assess changes in choroid plexus volumes in patients before and after spinal CSF leak repair.</p><p><strong>Materials and methods: </strong>This was a retrospective, institutional review board-approved study on patients with spinal CSF leak who had pre- and post-CSF leak repair MRI examinations. Brain MRIs with contrast were performed on a 1.5/3T scanner with acquisition of 3D T1 postcontrast (eg, Bravo, MPRAGE, and so forth). Choroid plexus volumes at the level of the trigonum ventriculi were calculated for the left and right sides on all pre- and posttreatment MRIs using Visage-7 segmentation tools. Basic demographic data, type of CSF leak, and choroid plexus volumes were recorded for all patients. Basic 2-tailed <i>t</i> tests were used to compare choroid plexus volumes between the pre- and posttreatment groups.</p><p><strong>Results: </strong>Twenty patients with spontaneous intracranial hypotension from spinal CSF leaks were included. Eleven patients (55%) had a type 1a (ventral tear) spinal CSF leak, 5 patients (25%) had type 1b (lateral tear), and 4 patients (20%) had a type 3 spinal CSF leak. The mean age was 47.6 years (SD, 13.8 years). The mean choroid plexus volumes pretreatment were 0.82 cm³ (SD, 0.29 cm³) compared with 0.38 cm³ (SD, 0.19 cm³) posttreatment (<i>P</i> value 0.01).</p><p><strong>Conclusions: </strong>Significantly decreased choroid plexus volumes were seen in patients with spontaneous intracranial hypotension following spinal CSF leak repair. This finding highlights the modulation and dynamic role of the choroid plexus in states of low CSF volumes.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":"598-601"},"PeriodicalIF":0.0,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143469922","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessment of Trigeminal Nerve Root Demyelination in Patients with Primary Trigeminal Neuralgia Using Macromolecular Proton Fraction Imaging.","authors":"Elena A Filimonova, Anton A Pashkov, Vasily L Yarnykh, Maria I Schukina, Boris A Zaitsev, Azniv V Martirosyan, Galina I Moysak, Jamil A Rzaev","doi":"10.3174/ajnr.A8545","DOIUrl":"10.3174/ajnr.A8545","url":null,"abstract":"<p><strong>Background and purpose: </strong>Primary trigeminal neuralgia (PTN) is a prevalent chronic pain disorder. This condition is believed to be associated with demyelination of the trigeminal nerve. Previous studies in this field have focused on diffusion tensor imaging, which has limited sensitivity and specificity to myelin. In the present study, we assessed the trigeminal nerve root via the macromolecular proton fraction (MPF) mapping technique. MPF demonstrated strong correlations with myelin histology in a number of earlier animal studies and is currently viewed as a promising clinical myelin biomarker.</p><p><strong>Materials and methods: </strong>We performed a prospective case-control study. Fifty-six patients with unilateral PTN and 27 healthy controls were included. All participants were evaluated by using high-resolution brain MR imaging, which included the MPF technique. MPF values from different parts of the trigeminal nerve root, such as the root entry zone (REZ) and central and lateral cisternal segments, were extracted. ANCOVAs were performed. Correlations between MPF values and Sindou grade, duration, and intensity of symptoms were also evaluated in patients with PTN.</p><p><strong>Results: </strong>A statistically significant decrease in the average MPF of the affected trigeminal nerve root was observed in the PTN group compared with the healthy control group (<i>P</i> < .01, false discovery rate [FDR] corrected). Specifically, reductions in the MPF values of the REZ and central cisternal parts of the affected trigeminal nerve root were found in patients with PTN (<i>P</i> < .01 and <i>P</i> < .05, respectively, FDR corrected). Furthermore, we identified a decrease in the average and REZ MPF values on the affected side compared with the contralateral side in patients with PTN (<i>P</i> < .05 and <i>P</i> < .001, respectively, FDR corrected). A negative correlation between MPF values in the REZ and Sindou grade was revealed (<i>R</i> = -0.35, adjusted <i>P</i> < .05).</p><p><strong>Conclusions: </strong>Our preliminary results suggest that MPF could serve as a new neuroimaging biomarker of trigeminal nerve root impairment in patients with PTN and enable noninvasive detection of nerve root demyelination.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":"602-610"},"PeriodicalIF":0.0,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143525460","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Performance of Automated Algorithm in Large and Medium Vessel Occlusion Detection: A Real-World Experience.","authors":"Aakanksha Sriwastwa, Yasmin N Aziz, Kara Weiss, Robert Buse, Bin Zhang, Stacie L Demel, Arafat Ali, Sriharsha Voleti, Lily Li-Li Wang, Achala S Vagal","doi":"10.3174/ajnr.A8509","DOIUrl":"10.3174/ajnr.A8509","url":null,"abstract":"<p><strong>Background and purpose: </strong>Fast, accurate detection of large (LVO) and medium vessel occlusion (MeVO) is critical for triage and management of acute ischemic stroke. Multiple artificial intelligence (AI)-based software programs are available commercially for automated detection and rapid prioritization of LVO. However, their ability, strengths, and limitations for detection of acute vessel occlusion in the context of expanding indications for mechanical thrombectomy are not entirely understood. We aimed to investigate the performance of a fully automated commercial detection algorithm to detect large and medium vessel occlusions in code stroke patients.</p><p><strong>Materials and methods: </strong>We utilized a single-center, institutional, retrospective registry of all consecutive code stroke patients with CTA and automated processing by using Viz.ai presenting at a large comprehensive stroke center between March 2020 and February 2023. LVO was categorized as anterior LVO (aLVO), defined as occlusion of the intracranial ICA or M1-MCA, and posterior LVO (pLVO), defined as occlusion of the basilar artery or V4-vertebral artery. MeVO was defined as occlusion of the M2-MCA, A1/A2-anterior cerebral artery, or P1/P2-posterior cerebral artery. We compared the accuracy of Viz.ai by using STARD guidelines. Radiology reports from 12 board-certified radiologists were considered the reference standard. Our primary outcome was assessing accuracy of the automated software for aLVO. Our secondary outcome was assessing accuracy for 3 additional categories: all LVO (aLVO and pLVO), aLVO with M2-MCA, and aLVO with MeVO.</p><p><strong>Results: </strong>Of 3590 code stroke patients, 3576 were technically sufficient for analysis by the automated software (median age 67 years; 51% women; 68% white), of which 616 (17.2%) had vessel occlusions. The respective sensitivity and specificity for our prespecified categories were: aLVO: 91% (87-94%), 93% (92-94%); all LVO: 73% (68-77%), 92% (91-93%); aLVO + M2-MCA occlusion: 74% (70-78%), 93% (92-94%); and aLVO + all MeVO: 65% (61-69%), 93% (92-94%).</p><p><strong>Conclusions: </strong>The automated algorithm demonstrated high accuracy in identifying anterior LVO with lower performance for pLVO and MeVO. It is crucial for acute stroke teams to be aware of the discordance between automated algorithm results and true rates of LVO and MeVO for timely diagnosis and triage.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":"476-482"},"PeriodicalIF":0.0,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142334164","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}