AJNR. American journal of neuroradiology最新文献

{"title":"Stent Retriever AssIsted Lysis Technique with Tirofiban: A Potential Bailout Alternative to Angioplasty and Stenting.","authors":"Marc Rodrigo-Gisbert, Matúš Hoferica, Alvaro García-Tornel, Manuel Requena, Marta Rubiera, Marta De Dios Lascuevas, Marta Olivé-Gadea, Francesco Diana, Federica Rizzo, Marian Muchada, Tomás Carmona, Noelia Rodriguez-Villatoro, David Rodríguez-Luna, Jesus Juega, Jorge Pagola, David Hernández, Carlos A Molina, Alejandro Tomasello, Christophe Cognard, Marc Ribó","doi":"10.3174/ajnr.A8374","DOIUrl":"10.3174/ajnr.A8374","url":null,"abstract":"<p><strong>Background and purpose: </strong>Angioplasty and stent placement have been described as a bailout technique in individuals with failed thrombectomy. We aimed to investigate Stent retriever AssIsted Lysis (SAIL) with tirofiban before angioplasty and stent placement.</p><p><strong>Materials and methods: </strong>Patients from 2 comprehensive stroke centers were reviewed (2020-2023). We included patients with failed thrombectomy and/or underlying intracranial stenosis who received SAIL with tirofiban before the intended angioplasty and stent placement. SAIL consisted of deploying a stent retriever through the occluding lesion to create a bypass channel and infuse 10 mL of tirofiban for 10 minutes either intra-arterially or IV. The stent retriever was re-sheathed before retrieval. The primary end points were successful reperfusion (expanded TICI 2b-3) and symptomatic intracerebral hemorrhage. Additional end points included 90-day mRS 0-2 and mortality.</p><p><strong>Results: </strong>After a median of 3 (interquartile range, 2-4) passes, 44 patients received the SAIL bridging protocol with tirofiban, and later they were considered potential candidates for angioplasty and stent placement bailout (43.2%, intra-arterial SAIL). Post-SAIL successful reperfusion was obtained in 79.5%. A notable residual stenosis (>50%) after successful SAIL was observed in 45.7%. No significant differences were detected according to post-SAIL: successful reperfusion (intra-arterial SAIL, 80.0% versus IV-SAIL, 78.9%; <i>P </i>= .932), significant stenosis (33.3% versus 55.0%; <i>P </i>= .203), early symptomatic re-occlusion (0% versus 8.0%; <i>P </i>= .207), or symptomatic intracerebral hemorrhage (5.3% versus 8.0%; <i>P </i>= .721). Rescue angioplasty and stent placement were finally performed in 15 (34.1%) patients (intra-arterial SAIL 21.0% versus IV-SAIL 44%; <i>P </i>= .112). At 90 days, mRS 0-2 (intra-arterial SAIL 50.0% versus IV-SAIL 43.5%; <i>P </i>= .086) and mortality (26.3% versus 12.0%; <i>P </i>= .223) were also similar.</p><p><strong>Conclusions: </strong>In patients with stroke in which angioplasty and stent placement are considered, SAIL with tirofiban, either intra-arterial or IV, seems to safely induce sustained recanalization, offering a potential alternative to definitive angioplasty and stent placement.</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":"141289032","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":"Pericarotid Fat as a Marker of Cerebrovascular Risk.","authors":"Riccardo Cau, Nicoletta Anzalone, Lorenzo Mannelli, Myriam Edjlali, Antonella Balestrieri, Valentina Nardi, Giuseppe Lanzino, Amir Lerman, Jasjit S Suri, Luca Saba","doi":"10.3174/ajnr.A8300","DOIUrl":"https://doi.org/10.3174/ajnr.A8300","url":null,"abstract":"<p><p>Vascular inflammation is widely recognized as an important factor in the atherosclerotic process, particularly in terms of plaque development and progression. Conventional tests, such as measuring circulating inflammatory biomarkers, lack the precision to identify specific areas of vascular inflammation. In this context, noninvasive imaging modalities can detect perivascular fat changes, serving as a marker of vascular inflammation. This review aims to provide a comprehensive overview of the key concepts related to perivascular carotid fat and its pathophysiology. Additionally, we examine the existing literature on the association of pericarotid fat with features of plaque vulnerability and cerebrovascular events. Finally, we scrutinize the advantages and limitations of the noninvasive assessment of pericarotid fat.</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":"141989716","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":"\"Flow void sign\": flow artefact on T2-weighted MRI can be an indicator of dural defect location in ventral type 1 spinal CSF leaks.","authors":"Lalani Carlton Jones, Diogo G L Edelmuth, David Butteriss, Daniel J Scoffings","doi":"10.3174/ajnr.A8445","DOIUrl":"10.3174/ajnr.A8445","url":null,"abstract":"<p><p>Patients with spontaneous intracranial hypotension caused by type 1 dural defects typically have an epidural fluid collection on MRI, but the location of the defect is not usually readily identifiable on standard MRI sequences and can be at any point along the length of the collection. The most common location for type 1 leaks is ventral and as such are most commonly associated with ventral predominant epidural fluid. Dynamic myelography (either digital subtraction myelography or dynamic CT myelography) is currently the standard of care to localise the defect. We describe an imaging sign on T2-weighted images caused by CSF-flow egress at the site of the defect that may permit accurate prediction of the site of the CSF leak non-invasively. Importantly, this sign was only observed on 2D T2-weighted and STIR images and not on 3D acquisitions, which notably suppress artefact. This has implications for optimal MRI spine protocol construction. This sign can be used to limit myelographic range, reduce radiation dose and may increase diagnostic confidence to dural defect location.ABBREVIATIONS: dCTM = Dynamic CT Myelography; DSM = Digital Subtraction Myelography; SIH = Spontaneous Intracranial Hypotension.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141972358","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":"Hemodynamic characteristics in ruptured and unruptured intracranial aneurysms: a prospective cohort study utilizing the AneurysmFlow™ tool.","authors":"Dang Luu Vu, Van Hoang Nguyen, Huu An Nguyen, Quang Anh Nguyen, Anh Tuan Tran, Hoang Kien Le, Tat Thien Nguyen, Thu Trang Nguyen, Cuong Tran, Xuan Bach Tran, Chi Cong Le, Laurent Pierot","doi":"10.3174/ajnr.A8444","DOIUrl":"https://doi.org/10.3174/ajnr.A8444","url":null,"abstract":"<p><strong>Background and purpose: </strong>Hemodynamic factors significantly influence the onset, progression, and rupture of intracranial aneurysms (IAs). Current rupture risk prediction scores focus primarily on the clinical, anatomical and morphological aspects. This study aimed to investigate the hemodynamic characteristics differences between ruptured and unruptured IAs.</p><p><strong>Materials and methods: </strong>Conducted from July 2021 to July 2022, this prospective cohort study involved patients with ruptured and unruptured IAs undergoing digital subtraction angiography (DSA). Hemodynamic characteristics were assessed using the AneurysmFlow™ tool. Hemodynamic, clinical, anatomical and morphological parameters were compared between ruptured and unruptured IA groups.</p><p><strong>Results: </strong>The study included 127 patients with 135 aneurysms (67 ruptured, 68 unruptured). Complex flow patterns (type 3 and 4) were observed more frequently in ruptured aneurysms compared to unruptured aneurysms (odds ratio [OR], 5.57; 95% confidence interval [CI], 2.49-12.45; P < 0.001) in univariate analysis, and were also more common in unruptured aneurysms associated with daughter sacs features (P = 0.015). The mean aneurysm flow amplitude (MAFA) was lower in ruptured aneurysms, and associated with lower flow velocity in the parent artery related to vasospasm. MAFA in the aneurysmal dome or any additional daughter sacs was lowest compared to other regions inside the aneurysms. The technical failure rate of AneurysmFlow™ measurements was 8.5% (12 out of 139 patients). Additionally, hypertension (OR, 0.42; 95% CI, 0.30-0.54; P < 0.001), bifurcation location (AcomA/ACA/MCA/PcomA/posterior circulation) (OR, 0.17; 95% CI, 0.05-0.29; P = 0.005), and irregular shape (OR, 0.19; 95% CI, 0.05-0.35; P = 0.012) were identified as independently associated with rupture.</p><p><strong>Conclusions: </strong>Complex flow patterns identified on the AneurysmFlow™ tool are significantly more common in ruptured and unruptured aneurysms associated with daughter sac features. The lowest MAFA in the aneurysmal dome and daughter sacs likely indicates specific pathophysiological changes within the aneurysm wall associated with rupture incidence. Hypertension, bifurcation location, and an irregular shape are independently associated with the risk of rupture. Further multicenter studies with larger sample sizes are needed to validate these findings.</p><p><strong>Abbreviations: </strong>ACA = anterior cerebral artery; AcomA = anterior communicating artery; IAs = intracranial aneurysms; ICA = internal carotid artery; MAFA = mean aneurysm flow amplitude; MCA = middle cerebral artery; PcomA = posterior communicating artery; RIAs = ruptured intracranial aneurysms; SAH = subarachnoid hemorrhage; UIAs = unruptured intracranial aneurysms.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141972425","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":"Diagnostic Performance of Renal Contrast Excretion on Early Phase CT Myelography in Spontaneous Intracranial Hypotension.","authors":"Derek S Young, Timothy J Amrhein, Jacob T Gibby, Jay Willhite, Linda Gray, Michael Malinzak, Samantha Morrison, Erkanli Alaattin, Peter G Kranz","doi":"10.3174/ajnr.A8435","DOIUrl":"https://doi.org/10.3174/ajnr.A8435","url":null,"abstract":"<p><strong>Background and purpose: </strong>Early opacification of the renal collecting system during CT myelography (CTM) performed for the evaluation of Spontaneous Intracranial Hypotension (SIH) has been demonstrated in prior studies. However, these investigations often included CTMs scanned >30 minutes after intrathecal contrast injection, a longer delay than the myelographic techniques used in current practice. The purpose of this study was to determine whether renal contrast excretion (RCE) measured during this earlier time period (≤30 minutes) can discriminate patients with SIH from patients without SIH.</p><p><strong>Materials and methods: </strong>Single-center, retrospective cohort of consecutive patients presenting for evaluation of possible SIH between July 2021-May 2022. RCE was measured in both renal hila using standardized (5-15mm³) ROIs. ROC curves were constructed comparing RCE between patients with SIH to patients without SIH in the overall cohort, and within the subgroup of patients with negative myelograms.</p><p><strong>Results: </strong>The study cohort included 190 subjects. Both unadjusted and adjusted models demonstrated a statistically significant increase in renal contrast density among patients with SIH compared to those without SIH (p-values ≤ 0.001). The ROC curve showed moderate discrimination between these groups (AUC 0.76). However, using clinically meaningful test criteria of sensitivity >90% or specificity >90%, the two corresponding threshold HU values resulted in low specificity of 31.3% and sensitivity of 50.8%. Subgroup analysis of patients with negative myelograms showed poorer performance in discriminating SIH+ from SIH- (AUC 0.62). In this subgroup, using similar test criteria of sensitivity >90% or specificity >90 resulted in low specificities and sensitivities, at 26.0% and 37.5% respectively.</p><p><strong>Conclusions: </strong>We found a statistically significant positive association between RCE and SIH diagnosis during early-phase CTM, however clinically useful thresholds based on cutoff values for renal HU resulted in poor sensitivities or specificities, with substantial false positives or false negatives, respectively. Thus, while we confirmed statistically significant differences in RCE in the ≤30 min time period, in keeping with prior investigations of more delayed time periods, overlap in renal attenuation values prevented the development of clinically useful threshold value for discriminating SIH+ from SIH-patients.</p><p><strong>Abbreviations: </strong>SIH = spontaneous intracranial hypotension; RCE = renal contrast excretion; CTM = CT myelography; CVF = CSF-venous fistula; ICHD-3 = international classification of headache disorders third edition; CKD = chronic kidney disease.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141972424","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 and anesthesia protocol optimization in sedated clinical resting state fMRI.","authors":"Elmira Hassanzadeh, Alyssa Ailion, Masoud Hassanzadeh, Alena Hornak, Noam Peled, Dana Martino, Simon K Warfield, Zhou Lan, Taha Gholipour, Steven M Stufflebeam","doi":"10.3174/ajnr.A8438","DOIUrl":"https://doi.org/10.3174/ajnr.A8438","url":null,"abstract":"<p><strong>Background and purpose: </strong>The quality of resting-state functional MRI (rs-fMRI) under anesthesia is variable and there are no guidelines on optimal image acquisition or anesthesia protocol. We aim to identify the factors that may lead to compromised clinical rs-fMRI under anesthesia.</p><p><strong>Materials and methods: </strong>In this cross-sectional study, we analyzed clinical rs-fMRI data acquired under anesthesia from 2009-2023 at Massachusetts General Hospital. Independent component analysis driven resting state networks (RSN) of each patient were evaluated qualitatively and quantitatively and grouped as robust or weak. Overall networks were evaluated using the qualitative method, and motor and language networks were evaluated using the quantitative method. RSN robustness was analyzed in 4 outcome categories: overall, combined Motor-Language, individual motor, and language networks. Predictor variables included rs-fMRI acquisition parameters, anesthesia medications, underlying brain structural abnormalities, age, and sex. Logistic regression was used to examine the effect of the study variables on RSN robustness.</p><p><strong>Results: </strong>Sixty-nine patients were identified. With qualitative assessment, 40 had robust and 29 had weak overall RSN. Quantitatively, 45 patients had robust, while 24 had weak Motor-Language networks. Among all the predictor variables, only sevoflurane significantly contributed to the outcomes, with sevoflurane administration reducing the odds of having robust RSN in overall (Odds Radio (OR)= 0.2, 95% Confidence Interval (CI) = [0.05;0.79], p = .02), Motor-Language (OR = 0.18, 95% CI = [0.04;0.80], p = .02) and individual motor (OR= 0.1, 95% CI = [0.02;0.64], p= .02) categories. Individual language network robustness was not associated with the tested predictor variables.</p><p><strong>Conclusions: </strong>Sevoflurane anesthesia may compromise the visibility of fMRI resting state networks, particularly impacting motor networks. This finding suggests that the type of anesthesia is a critical factor in rs-fMRI quality. We did not observe the association of the MR acquisition technique or underlying structural abnormality with the RSN robustness.</p><p><strong>Abbreviations: </strong>BOLD = Blood Oxygen Level-Dependent; ICA = Independent Component Analysis; Rs-fMRI = Resting-State Functional Magnetic Resonance Imaging; RSN = Resting-State Networks; SNR = Signal-to-Noise Ratio.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141972426","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Outcome of Pipeline Embolization Device with and without Coil to Treat Intracranial Aneurysm: A Systematic Review and Meta-Analysis.","authors":"Irfan Kesumayadi, Makoto Sakamoto, Tomohiro Hosoya, Atsushi Kambe, Tetsuji Uno, Hiroki Yoshioka, Masamichi Kurosaki","doi":"10.3174/ajnr.A8443","DOIUrl":"https://doi.org/10.3174/ajnr.A8443","url":null,"abstract":"<p><strong>Background: </strong>The use of a Pipeline Embolization Device (PED) in combination with coils (PEDC) to treat intracranial aneurysms remains unclear as to whether it offers significant benefits for the patients since the results have varied.</p><p><strong>Purpose: </strong>This study aimed to investigate the clinical outcome of PEDC compared to PED in treating intracranial aneurysms.</p><p><strong>Data sources: </strong>We systematically searched the articles from PubMed, Web of Science, and the Cochrane Library databases published before January 25, 2024.</p><p><strong>Study selection: </strong>We selected studies comparing PEDC vs. PED to treat intracranial aneurysms. Patients treated with PEDC but using dense coiling were excluded from the study.</p><p><strong>Data analysis: </strong>The clinical outcomes observed in this meta-analysis were intraprocedural complications, postoperative complications (stenosis, stroke, hemorrhage, mortality), favorable outcome (mRS ≤ 2), complete occlusion rate, and retreatment rate. Forest plot was used to analyze pooled Odds Ratio (OR) of clinical outcomes.</p><p><strong>Data synthesis: </strong>A total of 3001 subjects from nine observational studies were included. PEDC was mainly used to treat larger aneurysms. PEDC has a significantly higher complete occlusion rate at 6 months [OR= 2.66, 95% CI(1.26, 5.59), p= 0.01], a lower retreatment rate [OR= 0.18, 95% CI(0.05, 0.07), p= 0.010], higher stroke-related complications [OR= 1.66, 95% CI(1.16, 2.37), p= 0.005], and higher hemorrhage-related complications [OR= 1.98, 95% CI(1.22, 3.21), p = 0.005]. There was no significant difference in intraprocedural complications, stenosis-related complications, mortality, favorable outcomes, and complete occlusion at the end of the study.</p><p><strong>Limitations: </strong>No randomized controlled trials have been performed comparing PEDC and PED. Considering that all the included studies were observational, the patients' baseline characteristics were not completely balanced.</p><p><strong>Conclusions: </strong>This meta-analysis study showed that PEDC in large intracranial aneurysms induces a faster complete occlusion rate at 6 months and a lower retreatment rate. However, it increases the risk of stroke-related postoperative complications, and the faster complete aneurysm occlusion rate found in this study did not correlate with a reduction in long-term aneurysm or distal artery ruptures. Thus, this study suggests the need to find a better strategy to improve long-term hemorrhage-related complications in large intracranial aneurysms.</p><p><strong>Abbreviations: </strong>F = female; FDDs = flow-diverter devices; M = male; NOS = Newcastle-Ottawa Scale; PED = pipeline embolization device; PEDC = pipeline embolization device in combination with coils.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141972379","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":"Diagnostic Performance of ASL-MRI and FDG-PET in Frontotemporal Dementia: A Systematic Review and Meta-Analysis.","authors":"Richard Dagher, Parisa Arjmand, Burak Berksu Ozkara, Mahla Radmard, Mona Gad, Ali Sheikhy, Max Wintermark, Vivek Yedavalli, Haris I Sair, Licia P Luna","doi":"10.3174/ajnr.A8440","DOIUrl":"https://doi.org/10.3174/ajnr.A8440","url":null,"abstract":"<p><strong>Background: </strong>While the diagnosis of frontotemporal dementia (FTD) is based mostly on clinical features, [18F]-FDG PET has been investigated as a potential imaging golden standard in ambiguous cases, with arterial spin labeling (ASL) MRI gaining recent interest.</p><p><strong>Purpose: </strong>The purpose of this study is to conduct a systematic review and meta-analysis on the diagnostic performance of ASL MRI in FTD patients and compare it to that of [18F]-FDG PET.</p><p><strong>Data sources: </strong>A systematic search of PubMed, Scopus and EMBASE was conducted until March 13, 2024.</p><p><strong>Study selection: </strong>Inclusion criteria were: original articles, patients with FTD and/or its variants, use of ASL MR perfusion imaging with or without [18F]-FDG PET, presence of sufficient diagnostic performance data. Exclusion criteria were: meeting abstracts, comments, summaries, protocols, letters and guidelines, longitudinal studies, overlapping cohorts.</p><p><strong>Data analysis: </strong>The quality of eligible studies was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2. Pooled sensitivity, specificity, and diagnostic odds ratio (DOR) for [18F]-FDG PET and ASL MRI were calculated, and a summary receiver operating characteristic curve was plotted.</p><p><strong>Data synthesis: </strong>Seven eligible studies were identified, which included a total of 102 FTD patients. Aside from some of the studies showing at worst an unclear risk of bias in patient selection, index test, flow and timing, all studies showed low risk of bias and applicability concerns in all categories. Data from 4 studies was included in our meta-analysis for ASL MRI and 3 studies for [18F]-FDG PET. Pooled sensitivity, specificity and DOR were 0.70 (95% CI: 0.59-0.79), 0.81 (95% CI: 0.71-0.88) and 8.00 (95% CI: 3.74-17.13) for ASL MRI, and 0.88 (95% CI: 0.71-0.96), 0.89 (95% CI: 0.43-0.99) and 47.18 (95% CI: 10.77-206.75) for [18F]-FDG PET.</p><p><strong>Limitations: </strong>The number of studies was relatively small, with a small sample size. The studies used different scanning protocols as well as a mix of diagnostic metrics, all of which might have introduced heterogeneity in the data.</p><p><strong>Conclusions: </strong>While ASL MRI performed worse than [18F]-FDG PET in the diagnosis of FTD, it exhibited a decent diagnostic performance to justify its further investigation as a quicker and more convenient alternative.</p><p><strong>Abbreviations: </strong>3DPCASL, 3D pseudocontinuous ASL; AD, Alzheimer's disease; ASL, arterial spin labeling; AUC, area under the curve; CI, confidence interval; DOR, diagnostic odds ratio; FN, false negative; FP, false positive; FTD, frontotemporal dementia; LE, limbic encephalitis; NLR, negative likelihood ratio; PASL, pulsed ASL; PLD, post-label delay; PLR, positive likelihood ratio; PRISMA, PSP, progressive supranuclear palsy; Preferred Reporting Items for Systematic Reviews and Meta-Analysis;","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141972423","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":"Safety and technical performance of bilateral decubitus CT myelography using standard versus increased intrathecal iodinated contrast volume.","authors":"Diogo G L Edelmuth, Renata V Leão, Eduardo Nk Filho, Marcio Np Souza, Marcelo Calderaro, Peter G Kranz","doi":"10.3174/ajnr.A8436","DOIUrl":"https://doi.org/10.3174/ajnr.A8436","url":null,"abstract":"<p><strong>Background and purpose: </strong>Lateral decubitus CT myelography (LDCTM) is one of the main studies for the detection of CSF-venous fistulas (CVF), but detection of CVFs is dependent on intrathecal contrast density. The purpose of this investigation was to assess tolerability and technical performance of increased intrathecal doses of myelographic contrast compared to standard doses.</p><p><strong>Materials and methods: </strong>Retrospective series of 24 patients who underwent LDCTM following administration of either 10 or 20 ml of intrathecal iodinated contrast media (300 or 320mg/mL iodine content). Patients were scanned in the initial lateral decubitus position, then turned to the contralateral side and re-scanned in the same session. Safety and tolerability of the 20 ml dosage was assessed from clinical records. Technical performance of the studies was compared between groups by measuring attenuation values over the lateral thecal sac at standardized levels. Both the initial scan and the scan after turning to the contralateral side were assessed.</p><p><strong>Results: </strong>No moderate or severe adverse event was recorded in either group. The 20-ml group showed higher attenuation values, which were statistically greater on the second side examined compared to the standard-dose group.</p><p><strong>Conclusions: </strong>Increased volume of intrathecal contrast was well-tolerated and improved technical performance of LDCTM in this limited series. Further assessment of safety and impact on diagnostic yield using larger patient cohorts is warranted.</p><p><strong>Abbreviations: </strong>LDCTM = lateral decubitus CT myelography; CVF = CSF-venous fistula; IOCM = iodinated contrast media.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141972429","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":"CT-Guided Epidural Contrast Injection for the Identification of Dural Defects.","authors":"Ian T Mark, Michael P Oien, John C Benson, Jared T Verdoorn, Ben Johnson-Tesch, D K Kim, Jeremy Cutsforth-Gregory, Ajay A Madhavan","doi":"10.3174/ajnr.A8437","DOIUrl":"https://doi.org/10.3174/ajnr.A8437","url":null,"abstract":"<p><p>Post-dural puncture headache (PDPH) is an increasingly recognized cause of chronic headache. Outside of clinical history and myelography that requires an additional dural puncture, there is no reliable diagnostic test to evaluate for persistent dural defects. We describe the injection of iodinated contrast into the dorsal epidural space under CT guidance in five patients as a potential tool to visualize persistent dural defects.ABBREVIATIONS: PDPH = post-dural puncture headache; SIH = spontaneous intracranial hypotension; DSM = digital subtraction myelography; CTM = CT myelography.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141972422","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}