AJNR. American journal of neuroradiology最新文献

{"title":"Automated Detection of Normal Pressure Hydrocephalus Using CT Imaging for Calculating the Ventricle-to-Subarachnoid Volume Ratio.","authors":"Jacob J Knittel, Justin L Hoskin, Dylan J Hoyt, Jonathan A Abdo, Emily L Foldes, Molly M McElvogue, Clay M Oliver, Daniel A Keesler, Terry D Fife, F David Barranco, Kris A Smith, J Gordon McComb, Matthew T Borzage, Kevin S King","doi":"10.3174/ajnr.A8451","DOIUrl":"10.3174/ajnr.A8451","url":null,"abstract":"<p><strong>Background and purpose: </strong>Normal pressure hydrocephalus (NPH) is a diagnostic challenge because its clinical symptoms and imaging appearance resemble normal aging and other forms of dementia. Identifying NPH is essential so that patients can receive timely treatment to improve gait distortion and quality of life. An automated marker of NPH was developed and evaluated on clinical CT images, and its utility was assessed in a large patient cohort.</p><p><strong>Materials and methods: </strong>A retrospective review was conducted of CT images from 306 tap test-responsive patients with NPH between January 2015 and January 2022. Control CT images were obtained from patients in the emergency department who were evaluated for headache and had unremarkable CT findings between June 2021 and August 2022. The ventricle-to-subarachnoid volume ratio (VSR) was automatically calculated by the imaging software and used as a predictor of NPH in linear regression modeling with adjustment for age and sex. The correlations of VSR with age, sex, and the receiver operating characteristic were computed.</p><p><strong>Results: </strong>VSR was significantly greater in patients with NPH than controls (<i>P</i> < .001). Importantly, VSR was not significantly correlated with age (<i>P</i> = .56, <i>R²</i> = 0.001). VSR identifies NPH with a sensitivity and specificity of 94.1% and 92.5%, respectively, with an area under the receiver operating characteristic curve of 0.99 (95% CI 0.975-0.995).</p><p><strong>Conclusions: </strong>Automated assessment of the VSR on head CT images identified probable NPH with 93% accuracy. The assessment of a large cohort of patients with NPH supports the generalizability of clinical screening of CT images. Moreover, the results support the utility of ventricle-to-sulcal concordance often used by radiologists but not currently a part of the accepted guidelines for imaging markers of NPH.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":"141-146"},"PeriodicalIF":0.0,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11735426/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142923960","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":"Incorporation of Edited MRS into Clinical Practice May Improve Care of Patients with <i>IDH</i>-Mutant Glioma.","authors":"Lucia Nichelli, Capucine Cadin, Patrizia Lazzari, Bertrand Mathon, Mehdi Touat, Marc Sanson, Franck Bielle, Małgorzata Marjańska, Stéphane Lehéricy, Francesca Branzoli","doi":"10.3174/ajnr.A8413","DOIUrl":"10.3174/ajnr.A8413","url":null,"abstract":"<p><strong>Background and purpose: </strong>Isocitrate dehydrogenase (<i>IDH</i>) mutation and 1p/19q codeletion classify adult-type diffuse gliomas into 3 tumor subtypes with distinct prognoses. We aimed to evaluate the performance of edited MR spectroscopy for glioma subtyping in a clinical setting, via the quantification of D-2-hydroxyglutarate (2HG) and cystathionine. The delay between this noninvasive classification and the integrated histomolecular analysis was also quantified.</p><p><strong>Materials and methods: </strong>Subjects with presumed low-grade gliomas eligible for surgery (cohort 1) and subjects with <i>IDH</i>-mutant gliomas previously treated and with progressive disease (cohort 2) were prospectively examined with a single-voxel Mescher-Garwood point-resolved spectroscopy sequence at 3T. Spectra were quantified using LCModel. The Cramér-Rao lower bounds threshold was set to 20%. Integrated histomolecular analysis according to the 2021 WHO classification was considered as ground truth.</p><p><strong>Results: </strong>Thirty-four consecutive subjects were enrolled. Due to poor spectra quality and lack of histologic specimens, data from 26 subjects were analyzed. Twenty-one belonged to cohort 1 (11 women; median age, 42 years); and 5, to cohort 2 (3 women; median age, 48 years). Edited MR spectroscopy showed 100% specificity for detection of <i>IDH</i>-mutation and 91% specificity for the prediction of 1p/19q-codeletion status. Sensitivities for the prediction of <i>IDH</i> and 1p/19q codeletion were 69% and 33%, respectively. The median Cramér-Rao lower bounds values were 16% (13%-28%) for <i>IDH</i>-mutant and 572% (554%-999%) for <i>IDH</i> wild type tumors. The time between MR spectroscopy and surgery was longer for low-grade than for high-grade gliomas (<i>P </i>= .03), yet the time between MR spectroscopy and WHO diagnosis did not differ between grades (<i>P </i>= .07), possibly reflecting molecular analyses-induced delays in high-grade gliomas.</p><p><strong>Conclusions: </strong>Our results, acquired in a clinic setting, confirmed that edited MR spectroscopy is highly specific for both <i>IDH-</i>mutation and 1p/19q-codeletion predictions and can provide a faster prognosis stratification. In the upcoming IDH-inhibitor treatment era, incorporation of edited MR spectroscopy into clinical workflow is desirable.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":"113-120"},"PeriodicalIF":0.0,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11735446/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141602365","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 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 D Malinzak, Samantha Morrison, Alaattin Erkanli, Peter G Kranz","doi":"10.3174/ajnr.A8435","DOIUrl":"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>A single-center, retrospective cohort of consecutive patients presenting for evaluation of possible SIH between July 2021 and May 2022 was studied. RCE was measured in both renal hila by using standardized (5-15 mm³) ROIs. Receiver operating characteristic (ROC) curves were constructed by comparing RCE between patients with SIH and 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 attenuation among patients with SIH compared with those without SIH (<i>P</i> values ≤.001). The ROC curve showed moderate discrimination between these groups (area under the ROC curves [AUC] 0.76). However, by using clinically meaningful test criteria of sensitivity >90% or specificity >90%, the 2 corresponding threshold hounsfield units (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-minute period, in keeping with prior investigations of more delayed time periods, overlap in renal attenuation values prevented the development of clinically useful threshold values for discriminating SIH+ from SIH- patients.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":"194-199"},"PeriodicalIF":0.0,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11735437/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141972424","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":"Reply.","authors":"Benjamin M Ellingson, Francesco Sanvito, Whitney B Pope, Timothy F Cloughesy, Raymond Y Huang, Javier E Villanueva-Meyer, Daniel P Barboriak, Lalitha K Shankar, Marion Smits, Timothy J Kaufmann, Jerrold L Boxerman, Michael Weller, Evanthia Galanis, John de Groot, Susan M Chang, Mark R Gilbert, Andrew B Lassman, Mark S Shiroishi, Ali Nabavizadeh, Minesh Mehta, Roger Stupp, Wolfgang Wick, David A Reardon, Patrick Y Wen, Michael A Vogelbaum, Martin van den Bent","doi":"10.3174/ajnr.A8621","DOIUrl":"10.3174/ajnr.A8621","url":null,"abstract":"","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":"221-222"},"PeriodicalIF":0.0,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11735428/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142900626","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":"Deep Learning-Based Super-Resolution Reconstruction on Undersampled Brain Diffusion-Weighted MRI for Infarction Stroke: A Comparison to Conventional Iterative Reconstruction.","authors":"Shuo Zhang, Meimeng Zhong, Hanxu Shenliu, Nan Wang, Shuai Hu, Xulun Lu, Liangjie Lin, Haonan Zhang, Yan Zhao, Chao Yang, Hongbo Feng, Qingwei Song","doi":"10.3174/ajnr.A8482","DOIUrl":"10.3174/ajnr.A8482","url":null,"abstract":"<p><strong>Background and purpose: </strong>DWI is crucial for detecting infarction stroke. However, its spatial resolution is often limited, hindering accurate lesion visualization. Our aim was to evaluate the image quality and diagnostic confidence of deep learning (DL)-based super-resolution reconstruction for brain DWI of infarction stroke.</p><p><strong>Materials and methods: </strong>This retrospective study enrolled 114 consecutive participants who underwent brain DWI. The DWI images were reconstructed with 2 schemes: 1) DL-based super-resolution reconstruction (DWI_DL); and 2) conventional compressed sensing reconstruction (DWI_CS). Qualitative image analysis included overall image quality, lesion conspicuity, and diagnostic confidence in infarction stroke of different lesion sizes. Quantitative image quality assessments were performed by measurements of SNR, contrast-to-noise ratio (CNR), ADC, and edge rise distance. Group comparisons were conducted by using a paired <i>t</i> test for normally distributed data and the Wilcoxon test for non-normally distributed data. The overall agreement between readers for qualitative ratings was assessed by using the Cohen <i>κ</i> coefficient. A <i>P</i> value less than .05 was considered statistically significant.</p><p><strong>Results: </strong>A total of 114 DWI examinations constituted the study cohort. For the qualitative assessment, overall image quality, lesion conspicuity, and diagnostic confidence in infarction stroke lesions (lesion size <1.5 cm) improved by DWI_DL compared with DWI_CS (all <i>P</i> < .001). For the quantitative analysis, edge rise distance of DWI_DL was reduced compared with that of DWI_CS (<i>P</i> < .001), and no significant difference in SNR, CNR, and ADC values (all <i>P</i> > .05).</p><p><strong>Conclusions: </strong>Compared with the conventional compressed sensing reconstruction, the DL-based super-resolution reconstruction demonstrated superior image quality and was feasible for achieving higher diagnostic confidence in infarction stroke.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":"46 1","pages":"41-48"},"PeriodicalIF":0.0,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11735436/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142960153","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":"<i>IDH</i> Status in Brain Gliomas Can Be Predicted by the Spherical Mean MRI Technique.","authors":"Vojtěch Sedlák, Milan Němý, Martin Májovský, Adéla Bubeníková, Love Engstrom Nordin, Tomáš Moravec, Jana Engelová, Dalibor Sila, Dora Konečná, Tomáš Belšan, Eric Westman, David Netuka","doi":"10.3174/ajnr.A8432","DOIUrl":"10.3174/ajnr.A8432","url":null,"abstract":"<p><strong>Background and purpose: </strong>Diffuse gliomas, a heterogeneous group of primary brain tumors, have traditionally been stratified by histology, but recent insights into their molecular features, especially the <i>IDH</i> mutation status, have fundamentally changed their classification and prognosis. Current diagnostic methods, still predominantly relying on invasive biopsy, necessitate the exploration of noninvasive imaging alternatives for glioma characterization.</p><p><strong>Materials and methods: </strong>In this prospective study, we investigated the utility of the spherical mean technique (SMT) in predicting the <i>IDH</i> status and histologic grade of adult-type diffuse gliomas. Patients with histologically confirmed adult-type diffuse glioma underwent a multiparametric MRI examination using a 3T system, which included a multishell diffusion sequence. Advanced diffusion parameters were obtained using SMT, diffusional kurtosis imaging, and ADC modeling. The diagnostic performance of studied parameters was evaluated by plotting receiver operating characteristic curves with associated area under curve, specificity, and sensitivity values.</p><p><strong>Results: </strong>A total of 80 patients with a mean age of 48 (SD, 16) years were included in the study. SMT metrics, particularly microscopic fractional anisotropy (μFA), intraneurite voxel fraction, and μFA to the third power (μFA³), demonstrated strong diagnostic performance (all AUC = 0.905, 95% CI, 0.835-0.976; <i>P</i> < .001) in determining <i>IDH</i> status and compared favorably with diffusional kurtosis imaging and ADC models. These parameters also showed a strong predictive capability for tumor grade, with intraneurite voxel fraction and μFA achieving the highest diagnostic accuracy (AUC = 0.937, 95% CI, 0.880-0.993; <i>P</i> < .001). Control analyses on normal-appearing brain tissue confirmed the specificity of these metrics for tumor tissue.</p><p><strong>Conclusions: </strong>Our study highlights the potential of SMT for noninvasive characterization of adult-type diffuse gliomas, with a potential to predict <i>IDH</i> status and tumor grade more accurately than traditional ADC metrics. SMT offers a promising addition to the current diagnostic toolkit, enabling more precise preoperative assessments and contributing to personalized treatment planning.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":"46 1","pages":"121-128"},"PeriodicalIF":0.0,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11735434/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142960129","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":"Prevalence of Spinal Meningeal Diverticula in Autosomal Dominant Polycystic Kidney Disease.","authors":"Usama Sattar, Xiaorui Yin, Xianfu Luo, Chenglin Zhu, Zhongxiu Hu, Jon D Blumenfeld, Hanna Rennert, Alan Wu, Arindam RoyChoudhury, Gayle Salama, Martin R Prince","doi":"10.3174/ajnr.A8407","DOIUrl":"10.3174/ajnr.A8407","url":null,"abstract":"<p><strong>Background and purpose: </strong>Patients with autosomal dominant polycystic kidney disease (ADPKD) develop cysts in the kidneys, liver, spleen, pancreas, prostate, and arachnoid spaces. In addition, spinal meningeal diverticula have been reported. To determine whether spinal meningeal diverticula are associated with ADPKD, we compared their prevalence in subjects with ADPKD with a control cohort without ADPKD.</p><p><strong>Materials and methods: </strong>Subjects with ADPKD and age- and sex-matched controls without ADPKD undergoing abdominal MRI from the midthorax to the pelvis from 2003 to 2023 were retrospectively evaluated for spinal meningeal diverticula by 4 blinded observers. The prevalence of spinal meningeal diverticula in ADPKD was compared with that in control subjects, using <i>t</i> tests and correlated with clinical and laboratory data and MR imaging features, including cyst volumes and cyst counts.</p><p><strong>Results: </strong>Identification of spinal meningeal diverticula in ADPKD (<i>n</i> = 285, median age, 47; interquartile range [IQR], 37-56 years; 54% female) and control (<i>n</i> = 285, median age, 47; IQR, 37-57 years; 54% female) subjects had high interobserver agreement (pairwise Cohen κ = 0.74). Spinal meningeal diverticula were observed in 145 of 285 (51%) subjects with ADPKD compared with 66 of 285 (23%) control subjects without ADPKD (<i>P</i> < .001). Spinal meningeal diverticula in ADPKD were more prevalent in women (98 of 153 [64%]) than men (47 of 132 [36%], <i>P</i> < .001). The mean number of spinal meningeal diverticula per affected subject with ADPKD was 3.6 ± 2.9 compared with 2.4 ± 1.9 in controls with cysts (<i>P</i> < .001). The median volume (IQR, 25%-75%) of spinal meningeal diverticula was 400 (IQR, 210-740) mm³ in those with ADPKD compared with 250 (IQR, 180-440) mm³ in controls (<i>P</i> < .001). The mean spinal meningeal diverticulum diameter was greater in the sacrum (7.3 [SD, 4.1] mm) compared with thoracic (5.4 [SD, 1.8] mm) and lumbar spine (5.8 [SD, 2.0] mm), (<i>P</i> < .001), suggesting that hydrostatic pressure contributed to enlargement.</p><p><strong>Conclusions: </strong>ADPKD has a high prevalence of spinal meningeal diverticula, particularly in women.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":"200-206"},"PeriodicalIF":0.0,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11735424/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141592348","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":"Reply.","authors":"Tshea Dowers, Paula Alcaide-Leon","doi":"10.3174/ajnr.A8538","DOIUrl":"10.3174/ajnr.A8538","url":null,"abstract":"","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":"224"},"PeriodicalIF":0.0,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11735422/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142559692","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":"Safety and Efficacy of Ultrasound-Guided Thrombin Injection for Pseudoaneurysms Arising after Ultrasound-Guided Biopsy of Thyroid Nodules.","authors":"Taehyuk Ham, Ji Ye Lee, Young Hun Jeon, Kyu Sung Choi, Inpyeong Hwang, Roh-Eul Yoo, Tae Jin Yun, Seung Hong Choi, Ji-Hoon Kim","doi":"10.3174/ajnr.A8428","DOIUrl":"10.3174/ajnr.A8428","url":null,"abstract":"<p><p>Iatrogenic pseudoaneurysm is a rare but potentially fatal complication of a thyroid biopsy. However, a standard management strategy has not yet been established. We aimed to evaluate the efficacy and safety of ultrasound (US)-guided thrombin injection (TI) for thyroid pseudoaneurysms. This retrospective study included 7256 patients who underwent thyroid biopsy and TI from January 2020 to January 2024. The technical success, clinical efficacy, and complication rates were evaluated. A total of 0.1% (7/7256) of pseudoaneurysms developed after thyroid biopsy. Except for 1 case that showed obliteration with manual compression, the remaining 6 refractory aneurysms (0.08%) were managed with US-guided TI. All cases (100%) were successfully occluded with US-guided TI. No major complications were observed. One patient (16.7%) developed transient loss of consciousness, which spontaneously resolved within a few seconds. US-guided TI is an effective, relatively safe, and minimally invasive method for managing pseudoaneurysms after thyroid biopsy.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":"166-169"},"PeriodicalIF":0.0,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11735430/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142604326","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":"Triple Aspiration versus Conventional Aspiration Techniques: A Randomized In Vitro Evaluation.","authors":"Cem Bilgin, Jiahui Li, Esref Alperen Bayraktar, Ryan M Naylor, Alexander A Oliver, Yasuhito Ueki, Jonathan R Cortese, Lorenzo Rinaldo, Ramanathan Kadirvel, Waleed Brinjikji, Harry J Cloft, David F Kallmes","doi":"10.3174/ajnr.A8409","DOIUrl":"10.3174/ajnr.A8409","url":null,"abstract":"<p><strong>Background and purpose: </strong>A single-aspiration maneuver using a large-volume syringe is a common and effective technique for aspiration thrombectomy. Multiple aspiration cycles using large aspiration syringes have been proposed as a means to improve the efficacy over single aspiration. In this study, we sought to investigate the efficacy of a \"triple aspiration technique\" in which a large-volume syringe is cycled 3 times before catheter retraction during aspiration thrombectomy.</p><p><strong>Materials and methods: </strong>A 3D-printed adult vasculature was used as a benchtop thrombectomy platform. Fibrin-rich and red blood cell-rich clots were prepared in centrifuge tubes using human plasma, red blood cells, and calcium chloride. Next, clots were placed in the carotid terminus of the model, and the performances of 3 different aspiration techniques-triple syringe, single syringe, and continuous pump aspiration-were compared in a randomized manner (1:1:1). Outcomes of interest included first-pass efficacy (FPE), complete clot removal (final modified TICI 2c/3), the number of thrombectomy attempts to achieve modified TICI 2c/3, vacuum pressure, and distal embolization. The distal emboli were detected using a 70-μm cell strainer placed at the outflow of the model and quantified using an image-processing algorithm. The vacuum pressures were measured using a pressure transducer.</p><p><strong>Results: </strong>A total of 102 replicates were performed, 34 for each technique. The triple-aspiration technique provided a significantly higher rate of FPE than the syringe and pump aspiration techniques (67.6% versus 41.1%, <i>P</i> = .02). Additionally, the triple-aspiration technique achieved complete clot removal with a significantly lower mean number of thrombectomy attempts compared with single-syringe aspiration (1.2 [SD, 0.5] versus 1.8 [SD, 0.8], <i>P</i> = .005). The triple-aspiration technique generated significantly higher mean vacuum pressure than both the single-syringe and vacuum pump aspiration (28.3 [SD, 0.2] versus 27.2 [SD, 0.3], <i>P</i> = .002 and 26.2 [SD, 0.4], <i>P</i> = .001, respectively). The differences in complete clot removal and distal embolization parameters were not statistically significantly different across the groups.</p><p><strong>Conclusions: </strong>Our findings suggest that the triple aspiration technique can improve FPE rates and vacuum pressure in aspiration thrombectomy. Further studies are needed to examine the safety and efficacy of triple aspiration in the clinical setting.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":"90-95"},"PeriodicalIF":0.0,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11735431/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141592350","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}