AJNR. American journal of neuroradiology最新文献

{"title":"Two-Step Semi-Automated Classification of Choroidal Metastases on MRI: Orbit Localization via Bounding Boxes Followed by Binary Classification via Evolutionary Strategies.","authors":"Jeffrey S Shi, Bala McRae-Posani, Sofia Haque, Andrei Holodny, Hrithwik Shalu, Joseph Stember","doi":"10.3174/ajnr.A8998","DOIUrl":"https://doi.org/10.3174/ajnr.A8998","url":null,"abstract":"<p><strong>Background and purpose: </strong>The choroid of the eye is a rare site for metastatic tumor spread, and as small lesions on the periphery of brain MRI studies, these choroidal metastases are often missed. To improve their detection, we aimed to use artificial intelligence to distinguish between brain MRI scans containing normal orbits and choroidal metastases.</p><p><strong>Materials and methods: </strong>We present a novel hierarchical deep learning framework for sequential cropping and classification on brain MRI images to detect choroidal metastases. The key innovation of this approach lies in training an orbit localization network based on a YOLOv5 architecture to focus on the orbits, isolating the structures of interest and eliminating irrelevant background information. The initial sub-task of localization ensures that the input to the subsequent classification network is restricted to the precise anatomical region where choroidal metastases are likely to occur. In Step 1, we trained a localization network on 386 T2-weighted brain MRI axial slices from 97 patients. Using the localized orbit images from Step 1, in Step 2 we trained a binary classifier network with 33 normal and 33 choroidal metastasis-containing brain MRIs. To address the challenges posed by the small dataset, we employed a data-efficient evolutionary strategies approach, which has been shown to avoid both overfitting and underfitting in small training sets.</p><p><strong>Results: </strong>Our orbit localization model identified globes with 100% accuracy and a mean Average Precision of Intersection over Union thresholds of 0.5 to 0.95 (mAP(0.5:0.95)) of 0.47 on held-out testing data. Similarly, the model generalized well to our Step 2 dataset which included orbits demonstrating pathologies, achieving 100% accuracy and mAP(0.5:0.95) of 0.44. mAP(0.5:0.95) appeared low because the model could not distinguish left and right orbits. Using the cropped orbits as inputs, our evolutionary strategies-trained convolutional neural network achieved a testing set area under the curve (AUC) of 0.93 (95% CI [0.83, 1.03]), with 100% sensitivity and 87% specificity at the optimal Youden's index.</p><p><strong>Conclusions: </strong>The semi-automated pipeline from brain MRI slices to choroidal metastasis classification demonstrates the utility of a sequential localization and classification approach, and clinical relevance for identifying small, \"corner-of-the-image\", easily overlooked lesions.</p><p><strong>Abbreviations: </strong>AI = artificial intelligence; AUC = area under the curve; CNN = convolutional neural network; DNE = deep neuroevolution; IoU = intersection over union; mAP = mean average precision; ROC = receiver operating characteristic.</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":"145031485","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":"Brain CT for Diagnosis of Intracranial Disease in Ambulatory Cancer Patients: Assessment of the Diagnostic Value of Scanning Without Contrast Prior to With Contrast.","authors":"Ethan Wang, Azad Darbandi, Long Tu, Leomar Y Ballester, Charles de Jesus Morales, Melissa Chen, Maria K Gule-Monroe, Jason M Johnson","doi":"10.3174/ajnr.A8995","DOIUrl":"https://doi.org/10.3174/ajnr.A8995","url":null,"abstract":"<p><strong>Background and purpose: </strong>Brain imaging with MRI or CT is standard in screening for intracranial disease among ambulatory cancer patients. Although MRI offers greater sensitivity, CT is frequently employed due to its accessibility, affordability, and faster acquisition time. However, the necessity of routinely performing a non-contrast CT with the contrast-enhanced study is unknown. This study evaluates the clinical and economic utility of the non-contrast portion of the brain CT examination.</p><p><strong>Materials and methods: </strong>A board-certified neuroradiologist reviewed 737 brain CT reports from outpatients at MD Anderson Cancer Center who underwent contrast and non-contrast CT for cancer staging (October 2014 to March 2016) to assess if significant findings were identified only on non-contrast CT. A GPT-3 model was then fine-tuned to extract reports with a high likelihood of unique and significant non-contrast findings from 1,980 additional brain CT reports (January 2017 to April 2022). These reports were manually reviewed by two neuroradiologists, with adjudication by a third reviewer if needed. The incremental cost-effectiveness ratio of non-contrast CT inclusion was then calculated based on Medicare reimbursement and the 95% confidence interval of the proportion of all reports in which non-contrast CT was necessary for identifying significant findings RESULTS: Seven of 737 reports in the initial dataset revealed significant findings unique to the non-contrast CT, all of which were hemorrhage. The GPT-3 model identified 145 additional reports with a high unique non-contrast CT finding likelihood for manual review from the second dataset of 1,980 reports. 19 of these reports were found to have unique and significant non-contrast CT findings. In total, 0.96% (95% CI: 0.63% -1.40%) of reports had significant findings identified only on non-contrast CT. The incremental cost-effectiveness ratio for identification of a single significant finding on non-contrast CT missed on the contrast-enhanced study was $1,855 to $4,122.</p><p><strong>Conclusions: </strong>In brain CT for ambulatory screening for intracranial disease in cancer patients, non-contrast CT offers limited additional diagnostic value compared to contrast-enhanced CT alone. Considering the associated financial cost, workload, and patient radiation exposure associated with performing a non-contrast CT, contrast-enhanced brain CT alone is sufficient for cancer staging in asymptomatic cancer patients.</p><p><strong>Abbreviations: </strong>GPT-3＝ Generative Pretrained Transformers 3.</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":"145031431","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":"Lumbosacral Plexus Magnetic Resonance Neurography in Autoimmune Nodopathy: A Quantitative Analysis.","authors":"Weichen Du, Qinzhou Wang, Ziyao Liu, Tixiao Shan, Meng Zhao, Ningning Wang, Xinjuan Jin, Jiaxiang Xin, Chunhai Li, Anning Li","doi":"10.3174/ajnr.A8969","DOIUrl":"10.3174/ajnr.A8969","url":null,"abstract":"<p><strong>Background and purpose: </strong>This study aimed to evaluate the diagnostic utility and imaging abnormalities identified through lumbosacral plexus magnetic resonance neurography (L-MRN) in patients with autoimmune nodopathy (AN).</p><p><strong>Materials and methods: </strong>This retrospective study included 16 patients with AN (12 with anti-NF155, 3 with anti-CNTN1, and 1 with anti-CASPR1 antibodies) and 18 healthy volunteers. Additionally, six AN patients were followed up longitudinally. At baseline, imaging features such as cauda equina enhancement and the presence of the \"sleeve sign\" were analyzed. The cross-sectional area (CSA) of nerve roots and the nerve-to-muscle T2 signal intensity (nT2s) from L3 to S1 was measured in both the AN baseline and control groups. For the follow-up group, CSA, T2 signal intensity, and radiomics features were evaluated and correlated with clinical parameters.</p><p><strong>Results: </strong>Characteristic imaging findings in AN included cauda equina enhancement (100%), pre-(90.9%) and postganglionic (72.7%) nerve enhancement, and the sleeve sign (68.8%). The nerve root CSA and nT2s was significantly larger in patients with AN compared to healthy controls (all <i>p</i><0.001), with no significant difference in cross-sectional area between the pre-and post-treatment groups (<i>p</i>>0.10). However, at L5-0.5cm, the nerve-to-muscle T2 signal intensity was reduced after treatment. (<i>p</i><0.05) Furthermore, 21 radiomic features were identified in the follow-up group. The change of inflammatory Rasch-Built Overall Disability Scale was significantly positively correlated with the change in L5L_NGTDM_Strength (r=0.89, <i>p</i><0.05) and significantly negatively correlated with the change in L5R_GLCM_IMC1(r=-0.93, <i>p</i><0.05) .</p><p><strong>Conclusions: </strong>Lumbosacral plexus MRN proved to be a valuable diagnostic tool for AN. Radiomic features also emerged as promising imaging biomarkers for assessing treatment efficacy.</p><p><strong>Abbreviations: </strong>AN＝autoimmune nodopathy; MRN＝ magnetic resonance neurography; EDX=electrodiagnostic; CSA = cross-sectional area; nT2s=nerve-to-muscle T2 signal intensity.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144982211","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 Translation of Hyperpolarized ¹³C Metabolic Probes for Glioma Imaging.","authors":"Adam W Autry, Yaewon Kim, Duy Dang, Hsin-Yu Chen, James B Slater, Robert A Bok, Duan Xu, Janine M Lupo, Jeremy W Gordon, Peder E Z Larson, Daniel B Vigneron, Yan Li, Susan M Chang","doi":"10.3174/ajnr.A8726","DOIUrl":"10.3174/ajnr.A8726","url":null,"abstract":"<p><p>Hyperpolarized carbon-13 (HP-¹³C) MRI enables the real-time measurement of dynamic metabolism by utilizing molecular probes whose magnetization has been transiently enhanced via dynamic nuclear polarization of ¹³C labels. Based on preclinical and clinical investigations demonstrating Warburg-related metabolic dysfunction and tricarboxylic acid (TCA)-cycle alterations in gliomas, HP-¹³C techniques appear very promising for overcoming conventional challenges to evaluating tumor burden and extent, early therapeutic response, and progression among patients noninvasively. This article surveys the multifaceted translational development of HP-¹³C MRI in the context of glioma imaging, while emphasizing innovation concerning the pharmacy production of hyperpolarized (HP) probes-[1-¹³C]/[2-¹³C]-pyruvate and [1-¹³C,5-¹²C]-α-ketoglutarate-that serve as nonradioactive metabolic contrast agents. Borrowing from practical experience, we present specific probe indications for isocitrate dehydrogenase (IDH)-wild-type glioblastomas and IDH-mutant gliomas together with example data to show the targeted, pathway-dependent function of these agents and their utility. Additional information pertaining to HP-¹³C hardware, acquisition, and postprocessing techniques provides an overview of the imaging methodology as it is currently performed at a leading institution. Considering the developing markers for progressive disease in glioblastomas and rapidly advancing capability, this unique imaging technology appears poised for translational impact following further evaluation.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":"1754-1764"},"PeriodicalIF":0.0,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12453463/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143569266","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":"In Utero MR Imaging for Fetuses with Small Head Sizes without Intracranial Abnormalities Detected on Ultrasonography.","authors":"Paul D Griffiths, Deborah Jarvis, Michael J Campbell, Hatem A Mousa, Sophie Earle, Christoph Lees, Thomas Everett","doi":"10.3174/ajnr.A8742","DOIUrl":"10.3174/ajnr.A8742","url":null,"abstract":"<p><strong>Background and purpose: </strong>Many studies have shown that in utero MR imaging (iuMRI) is a valuable adjunct to ultrasonography studies (USS) when a brain abnormality has been shown on USS. There is an increasing tendency, however, for fetal maternal experts to use iuMRI in fetuses with small heads but no evident brain abnormality on USS. The diagnostic and clinical value for that approach is not known at present, and the aim of this study is to close that gap in medical knowledge.</p><p><strong>Materials and methods: </strong>We recruited 200 women whose fetuses had small head sizes but no brain abnormality on USS, to assess the rate and type of intracranial abnormalities found on iuMRI. A retrospective analysis was made of the change in prognosis brought about by iuMRI-derived abnormalities. The relationship between the fetal head circumference measured on USS and the rate of brain abnormalities shown on iuMRI was also assessed to perform sensitivity/specificity analyses.</p><p><strong>Results: </strong>Intracranial abnormalities were present on iuMRI in 21/200 (10.5%; 95% CI, 7.0-15.5%) fetuses, and changes in prognosis were brought about (all worsened) following iuMRI in 16/21 (76.2%). There was an increased chance of an intracranial abnormality being present in fetuses with more severe reductions in head size.</p><p><strong>Conclusions: </strong>There is a high detection rate of intracranial abnormalities on iuMRI of fetuses with small head sizes (10.5%). In most cases, the intracranial abnormalities shown on iuMRI brought about a change in prognosis. There was an increased risk of intracranial abnormalities in fetuses with more severe reductions in head size. These data make a strong case in favor of offering iuMRI to women whose fetuses haves a small head size but no intracranial abnormality on USS.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":"46 9","pages":"1917-1924"},"PeriodicalIF":0.0,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12453473/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144982206","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":"Characterizing Liquid Embolic Distribution and Its Impact on Chronic Subdural Hematoma Outcomes following Middle Meningeal Artery Embolization.","authors":"Arjun Ganga, Elias Shaaya, Santos Santos-Fontanez, Joshua Feler, Radmehr Torabi, Krisztina Moldovan, Glenn Tung, Mahesh V Jayaraman, Dylan N Wolman","doi":"10.3174/ajnr.A8779","DOIUrl":"10.3174/ajnr.A8779","url":null,"abstract":"<p><strong>Background and purpose: </strong>The NCCT appearance of liquid embolic material post middle meningeal artery embolization (MMAE) for chronic subdural hematomas (cSDHs) is poorly described. We aimed to categorize the spectrum of postprocedural liquid embolic distribution and determine whether embolic penetration impacts resorption.</p><p><strong>Materials and methods: </strong>We retrospectively reviewed patients with cSDH >5 mm at a single institution from 2019-2024. Patients with <1 month of follow-up imaging or embolization with coils or particles were excluded. Embolic membrane penetration during angiography was recorded, and the postprocedural appearance of embolic material was classified. Regression analyses were performed to assess if specific embolic distributions were associated with greater resorption.</p><p><strong>Results: </strong>Eighty-eight patients (73.9% men; mean age 73.5 ± 11.2 years) with 109 unilateral cSDHs were included. Membrane penetration occurred in 39 cases (35.8%). On follow-up NCCT, liquid embolic material was visualized on the outer surface of the cSDH in 85 cases (78.0%), within the cSDH in 16 cases (14.7%), and on the inner surface of the cSDH in 8 cases (7.3%). <i>n</i>-BCA was more likely to penetrate the subdural membrane (55.1%) and reach deeper compartments (40.8%) compared with Onyx-18 (17.0% and 7.5%; both <i>P</i> < .0001). Membrane penetration was associated with greater mean absolute reduction (1.05 cm versus 0.66 cm, <i>P</i> < .001), mean percent reduction (73.8% versus 53.5%, <i>P</i> = .01), and a faster average resorption rate (0.013 mm/d versus 0.007 mm/d, <i>P</i> = .001). Deeper compartment penetration visualized on follow-up NCCT was associated with faster resorption on univariate analysis (0.014 mm/d versus 0.008 mm/d, <i>P</i> = .01) but did not impact absolute reduction, percent reduction, or complete resorption. In regression analysis, membrane penetration was associated with faster resorption (β = 0.004 mm/d, <i>P</i> = .04), greater percent reduction (β = 32.65%, <i>P</i> = .001), and nearly 4 times the odds of complete resolution (β = 1.38, <i>P</i> = .04).</p><p><strong>Conclusions: </strong>We present a framework for characterizing the appearance of liquid embolic agents after MMAE. Visualized membrane penetration during angiography was associated with greater and faster cSDH resorption and higher odds of complete resolution. <i>n</i>-BCA was associated with deeper compartment penetration; however, deeper compartment penetration on NCCT was not independently predictive of improved outcomes after adjustment for covariates.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":"1844-1850"},"PeriodicalIF":0.0,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12453455/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144058789","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 Ultrasound in Neck Node NI-RADS Category 2.","authors":"Richard Dagher, Alexander Khalaf, Susana Calle, Samir A Dagher, Komal B Shah, Amy Juliano, Ashley H Aiken, Kim O Learned","doi":"10.3174/ajnr.A8717","DOIUrl":"10.3174/ajnr.A8717","url":null,"abstract":"<p><strong>Background and purpose: </strong>The Neck Imaging Reporting and Data System (NI-RADS) scoring system standardized imaging surveillance of head and neck (H&N) cancer with risk classification. A nodal NI-RADS score of 2 on contrast-enhanced CT (CECT) of the neck indicates low suspicion for recurrence/persistent disease, and close follow-up or addition of PET is recommended. The unclear follow-up imaging findings and/or mild FDG uptake raise the patient's anxiety about potential delay in diagnosis and intervention while adding high imaging costs. Therefore, at our institution, diagnostic ultrasound (US)/US-guided fine-needle aspiration (US-FNA) is incorporated into our paradigm. We aim to evaluate US performance in nodal NI-RADS 2 on CECT as an alternative valuable tool in surveillance imaging guidelines.</p><p><strong>Materials and methods: </strong>We conducted a retrospective database search (2019-2024) for patients with primary H&N cancer (excluding thyroid cancer and melanoma), a single index neck node NI-RADS 2 on surveillance neck CECT, and a neck US/US-FNA performed within 3 months afterward for evaluation of the NI-RADS 2 node. We categorized US/US-FNA results as positive or negative and reviewed clinical and imaging follow-up, management, and nodal disease status up to 1 year following US. The incidence of nodal recurrence and US diagnostic performance were evaluated.</p><p><strong>Results: </strong>Of 90 patients, 36 (40%) had normal diagnostic US with no FNA performed and were thus considered negative, and 54 patients (60%) had abnormal US and hence concurrent US-FNA. Eighteen (33.3%) US-FNAs were positive for tumor: 27 with normal lymphoid tissue and 9 with indeterminate cytology (no viable malignant cells, acellular or atypia) were considered negative (66.7%). All positive US-FNAs resulted in management changes. Two patients with normal diagnostic US, 1 with negative FNA, and 1 with indeterminate FNA developed recurrence in these nodes within 1 year. The incidence of US-detected malignancy was 20% in patients with a nodal NI-RADS 2, surpassing the published rate of 14.3%. The sensitivity, accuracy, and negative predictive value of US/US-FNA in detecting tumor recurrence/persistence in nodal NI-RADS 2 are 81.8%, 95.6%, and 94.4%, respectively.</p><p><strong>Conclusions: </strong>Ultrasound demonstrated good diagnostic performance in the detection of nodal recurrence in patients with NI-RADS 2 on CECT. Its role as an alternative tool in surveillance should be considered.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":"1893-1899"},"PeriodicalIF":0.0,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12453457/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143494904","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":"Efficacy and Safety in the Use of Pipeline Vantage Shield Stent versus Pipeline Flex Shield Stent in the Treatment of Patients with Unruptured Intracranial Aneurysms: A Multicenter Study.","authors":"Andrés J Catalá, Andrés F Ortiz-Giraldo, María F Estévez-Ochoa, Camilo S Alvarado-Bedoya, Jose R Muñoz Ordoñez, Juan A Mejía, Laura Campaña Perilla, Carlos Díaz Pacheco, Alfredo Hernandez Ruiz, Juan Gonzalo Muñoz, Sydney Goldfeder de Gracia, Sergio E Serrano-Gomez, Adriana Reyes-Gonzalez, Carlos A Ferreira, Oliverio Vargas, Daniel Mantilla-García","doi":"10.3174/ajnr.A8719","DOIUrl":"10.3174/ajnr.A8719","url":null,"abstract":"<p><strong>Background and purpose: </strong>Unruptured intracranial aneurysms (IA) are pathologic bulging of the arterial walls that could rupture and cause SAH. Recently, stents with modified surfaces have been used as treatment for IA. Thus, comparing efficacy and security of the Pipeline Flex Embolization Device with Shield Technology (PED-Shield) and the Pipeline Vantage Embolization Device with Shield Technology (PEDV) contributes to the scientific literature. Aiming to determine the efficacy of these stents, we believe the PEDV is as effective and safe as the PED-Shield in management of patients with unruptured aneurysms.</p><p><strong>Materials and methods: </strong>We analyzed data through an anonymized, multicentered cohort from multiple interventional radiology services in Colombia from January 2017 until June 2023.</p><p><strong>Results: </strong>Our study included 574 unruptured IA in 546 patients. At 12 months, overall adequate O'Kelly-Marotta grading scale (OKM = C-D) angiographic results were 83%. For the PEDV stent it was 97% and for the PED-Shield stent it was 80% (<i>P</i> ≤ .001). Mortality was 0.9% (<i>P</i> = .34) and overall morbidity was 0.5% (PEDV 0.3% and PED-Shield 0.2%). Overall complication events were 3.1%, thromboembolic events were 2.1% in the PED-Shield stent, and 6.7% in the PEDV stent (<i>P</i> = .008). Overall bleeding complications were 1.7%, in the PED-Shield stent (0.9%) and 2 in the PEDV stent (1.4%).</p><p><strong>Conclusions: </strong>The PEDV stent improved efficacy in comparison with PED-Shield stent at 12 months while the PED-Shield stent showed a slightly better safety profile.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":"1814-1820"},"PeriodicalIF":0.0,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12453469/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143506693","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":"Patterns of Epidural Patch Distribution: The Influence of Spinal Level, Injection Technique, and Patch Volume/Composition on Craniocaudal and Ventral Epidural Dispersion.","authors":"Daniel Montes, Samantha L Pisani Petrucci, Debayan Bhaumik, Nadya Andonov, Peter Lennarson, Andrew L Callen","doi":"10.3174/ajnr.A8720","DOIUrl":"10.3174/ajnr.A8720","url":null,"abstract":"<p><strong>Background and purpose: </strong>Epidural patching with autologous blood and/or fibrin sealant is a common treatment for spinal CSF leaks, yet the factors influencing patch distribution remain poorly understood. This study aimed to analyze the craniocaudal (CC) and ventral epidural (VE) extent of epidural patch material and investigate the impact of variables such as patch volume (PV), composition, spinal level of injection, and patient habitus on distribution patterns.</p><p><strong>Materials and methods: </strong>This retrospective, cross-sectional cohort study included patients who underwent CT-guided epidural patching from January to September 2024. Inclusion criteria were age ≥18 years, dorsal interlaminar (DI) or transforaminal (TFO) epidural patching by using blood, fibrin, or both, and immediate postpatch imaging capturing the entire patch extent. Patch distribution was assessed for CC and VE spread. Statistical analyses included linear and logistic regression models, with multivariate analyses adjusting for confounders.</p><p><strong>Results: </strong>Of 152 patients patched during the study period, 33 met inclusion criteria (mean age 45.4 years; 84.1% women) with 44 spinal levels patched: cervical (6.8%), thoracic (68.2%), and lumbar (25%). Mean PV per needle was 7.2 mL, with a mean CC spread of 4.6 spinal levels. There was a positive relationship between PV and CC spread across all spinal levels (β = 0.29, <i>P</i> = .001). Patches in the cervical region demonstrated the highest CC spread efficiency (0.77 levels per milliliter) compared with thoracic (0.56 levels per milliliter) and lumbar patches (0.47 levels per milliliter; <i>P</i> < .01). DI injections achieved greater CC spread but less VE dispersion than TFO injections (5.0 versus 3.2 levels; <i>P</i> = .02; 58.8% versus 70.0%, <i>P</i> = .52). VE spread occurred in 61.4% of cases and followed a nonlinear pattern along the spine, with an inflection point at T3.</p><p><strong>Conclusions: </strong>The distribution of epidural patch material is influenced by spinal level, PV, composition, and injection approach. Cervical patches provide the greatest spread efficiency relative to volume, while DI approaches enhance CC spread but reduce ventral dispersion.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":"1931-1938"},"PeriodicalIF":0.0,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12453460/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143506701","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":"Recent Trends in Neuroradiologist Compensation and Clinical Productivity in Academic versus Non-Academic Settings.","authors":"Ajay Malhotra, Dheeman Futela, Seyedmehdi Payabvash, David Seidenwurm, Dheeraj Gandhi, Max Wintermark","doi":"10.3174/ajnr.A8741","DOIUrl":"10.3174/ajnr.A8741","url":null,"abstract":"<p><p>Awareness of trends in compensation and clinical productivity are important, especially in a competitive market for hiring radiologists. This study shows that in the last decade, clinical productivity as measured by median Work Relative Value Units for academic neuroradiologists remained greater (by 30%-40%) than for academic diagnostic radiologists overall throughout the study period. The median compensation for academic neuroradiologists remains approximately 20% less than that for nonacademic neuroradiologists. The median compensation increased at a faster rate for academic neuroradiologists (4.1% annually) than for nonacademic neuroradiologists (1.8% annually), similar to the trend for diagnostic radiologists overall, but the compensation increase across time has barely kept pace with inflation. Further studies are needed to address cuts in reimbursements for neuroimaging studies and the impact on clinical productivity and physician labor market dynamics.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":"46 9","pages":"1776-1779"},"PeriodicalIF":0.0,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12453454/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144982179","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}