AJNR. American journal of neuroradiology最新文献

{"title":"Automated Midline Shift Detection in Head CT Using Localization and Symmetry Techniques Based on User-Selected Slice.","authors":"Nooriel E Banayan, Hrithwik Shalu, Vaios Hatzoglou, Nathaniel Swinburne, Andrei Holodny, Zhigang Zhang, Joseph Stember","doi":"10.3174/ajnr.A8767","DOIUrl":"10.3174/ajnr.A8767","url":null,"abstract":"<p><strong>Background and purpose: </strong>Midline shift (MLS) is an intracranial pathology characterized by the displacement of brain parenchyma across the skull's midsagittal axis, typically caused by mass effect from space-occupying lesions or traumatic brain injuries. Prompt detection of MLS is crucial, because delays in identification and intervention can negatively impact patient outcomes. The gap we have addressed in this work is the development of a deep learning algorithm that encompasses the full severity range from mild to severe cases of MLS. Notably, in more severe cases, the mass effect often effaces the septum pellucidum, rendering it unusable as a fiducial point of reference.</p><p><strong>Materials and methods: </strong>We sought to enable rapid and accurate detection of MLS by leveraging advances in artificial intelligence (AI). Using a cohort of 981 patient CT scans with a breadth of cerebral pathologies from our institution, we manually chose an individual slice from each CT scan primarily based on the presence of the lateral ventricles and annotated 400 of these scans for the lateral ventricles and skull-axis midline by using Roboflow. Finally, we trained an AI model based on the You Only Look Once object detection system to identify MLS in the individual slices of the remaining 581 CT scans.</p><p><strong>Results: </strong>When comparing normal and mild cases to moderate and severe cases of MLS detection, our model yielded an area under the curve of 0.79 with a sensitivity of 0.73 and specificity of 0.72 indicating our model is sensitive enough to capture moderate and severe MLS and specific enough to differentiate them from mild and normal cases.</p><p><strong>Conclusions: </strong>We developed an AI model that reliably identifies the lateral ventricles and the cerebral midline across various pathologies in patient CT scans. Most importantly, our model accurately identifies and stratifies clinically significant and emergent MLS from nonemergent cases. This could serve as a foundational element for a future clinically integrated approach that flags urgent studies for expedited review, potentially facilitating more timely treatment when necessary.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":"46 9","pages":"1859-1867"},"PeriodicalIF":0.0,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12453480/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144982184","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":"Predicting White Matter Hyperintensity: Leveraging Portable MRI for Accessible Brain Health Screening.","authors":"Ian P Johnson, Hailey Brigger, Joel Smith, Emma Peasley, Alison Champagne, Lauren Littig, Dheeraj Lalwani, Gordon Sze, Seyedmehdi Payabvash, Basmah Safdar, Gail D'Onofrio, Charles Wira, Juan Eugenio Iglesias, Matthew S Rosen, Annabel Sorby-Adams, W Taylor Kimberly, Kevin N Sheth, Adam de Havenon","doi":"10.3174/ajnr.A8734","DOIUrl":"10.3174/ajnr.A8734","url":null,"abstract":"<p><strong>Background and purpose: </strong>Portable MRI (pMRI) has emerged as a cost-effective and accessible tool for the identification of white matter hyperintensities (WMH), an independent risk factor for stroke and dementia. Our objective was to confirm that pMRI can produce accurate WMH measurements and to develop and validate a risk model to predict WMH on pMRI for the purpose of identifying patients who may benefit from pMRI screening.</p><p><strong>Materials and methods: </strong>The development (<i>n</i> = 143) and validation (<i>n</i> = 127) cohorts included patients without acute neurologic pathology who received a pMRI at a tertiary care hospital between May 2020 and July 2024. The development cohort included pMRIs collected as part of a prospective WMH screening pilot program in the emergency department. The validation cohort was a retrospective collection of pMRIs obtained for separate research purposes. Conventional MRIs (cMRIs) in the validation cohort obtained within 3 months of pMRIs were used for additional validation and device agreement. The primary outcome was WMH burden greater than 10 mL, assessed via an axial T2-FLAIR sequence acquired on a 0.064T pMRI and quantified by using a WMH segmentation software developed to process sequences of any resolution. We used backwards selection to screen candidate variables and report the area under the curve of the resulting model.</p><p><strong>Results: </strong>The final model, which included age, systolic blood pressure >140, atrial fibrillation, and tobacco use, achieved an area under the curve (AUC) of 0.83 (95% CI, 0.75-0.90) in the development cohort (<i>n</i> = 143, 62.4 ± 12.6 years, 44% female, 36% nonwhite race) and 0.85 (95% CI, 0.77-0.92) in the validation cohort (<i>n</i> = 127, 65.2 ± 16.8 years, 51% female, 34% nonwhite race), with similar results by using WMH measurements derived from cMRI (<i>n</i> = 120, <i>P</i> = .98, AUC = 0.86, 95% CI, 0.77-0.93). Additionally, we confirmed agreement in WMH volumes between pMRI and cMRI (<i>n</i> = 120, <i>r</i> = 0.93, 95% CI, 0.90-0.95, <i>P</i> < .001).</p><p><strong>Conclusions: </strong>The WMH risk score demonstrated accurate performance and reproducibility across cohorts, supporting its potential as a screening tool for identifying patients at risk of moderate WMH burden. Appropriately targeted pMRI screening in high-risk individuals could allow providers and patients to proactively manage vascular risk factors and improve neurologic outcomes.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":"1786-1792"},"PeriodicalIF":0.0,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12406303/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143627159","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":"Comparative Efficacy and Safety of Intravenous Cangrelor versus Intravenous Glycoprotein IIb/IIIa Inhibitors after Mechanical Thrombectomy for Patients with Acute Ischemic Stroke: A Systematic Review and Meta-Analysis.","authors":"Ocílio Ribeiro Gonçalves, Ana B Santos, Anthony Hong, Gabriel de Almeida Monteiro, Leonardo Januário Campos Cardoso, Victor Arthur Ohannesian, Christian Ken Fukunaga, Társis Vinicius Cronemberger, João Victor Araújo de Oliveira, Bianca Leal Ribeiro, Márcio Yuri Ferreira, Raphael Bertani, João de Deus Costa Alves, Christian Ferreira, Kelson James Almeida, Yafell Serulle","doi":"10.3174/ajnr.A8868","DOIUrl":"10.3174/ajnr.A8868","url":null,"abstract":"<p><strong>Background: </strong>Intravenous cangrelor and Glycoprotein IIb/IIIa inhibitors (GP IIb/IIIa I) are current options in antiplatelet therapy during neurointerventional procedures, potentially enhancing reperfusion and preventing reocclusion. In specific conditions, these antiplatelet agents are employed as adjuvant to mechanical thrombectomy (MT), a procedure that is crucial for patients with acute ischemic stroke (AIS) with large vessel occlusion (LVO). However, direct comparisons of these drugs in this context remain limited.</p><p><strong>Purpose: </strong>To compare the efficacy and safety of cangrelor and GP IIb/IIIa I following MT for AIS.</p><p><strong>Data sources: </strong>Following PRISMA guidelines, we systematically searched PubMed, Embase, Cochrane Library, and Web of Science for studies involving AIS patients undergoing MT with intravenous cangrelor or GP IIb/IIIa I.</p><p><strong>Study selection: </strong>The initial search yielded 73 studies from PubMed, 549 studies from Embase, 21 studies from Cochrane, 121 studies from Web of Science, and 342 studies from Scopus, with 1,106 studies in total. After the removal of 536 duplicates, 570 articles underwent initial screening, from which 542 were excluded based on the information provided in the abstract and title, leaving 28 articles for full-text assessment for eligibility. Ultimately, five cohort observational studies were included.</p><p><strong>Data analysis: </strong>All statistical analyses were performed using R (version 4.4.0, R Foundation for Statistical Computing, Vienna, Austria). Efficacy outcomes included successful reperfusion and favorable functional outcomes, while safety outcomes assessed symptomatic intracerebral hemorrhage (sICH), hemorrhagic transformation, and all-cause mortality. Risk ratios (RR) with 95% confidence intervals were calculated, with significance set at <i>P</i> < .05.</p><p><strong>Results: </strong>Five retrospective cohort studies comprising 630 patients were included, with 191 participants in the cangrelor group (30.32%). There was no significant difference in favorable functional outcomes (RR 1.10; 0.71-1.68; <i>P</i> > .05; <i>I</i> ² = 76%). However, cangrelor was associated with better successful reperfusion (RR 1.07; 1.01-1.13; <i>P</i> < .05; <i>I</i> ² = 60%). All-cause mortality (RR 1.33; 0.82-2.15; <i>P</i> > .05; <i>I</i> ² = 0%), sICH (RR 0.63; 0.33-1.23; <i>P</i> > .05; <i>I</i> ² = 23%) and hemorrhagic transformation (RR 0.80; 0.50-1.27; <i>P</i> > .05; <i>I</i> ² = 64%) were not significantly different between the groups.</p><p><strong>Conclusions: </strong>Cangrelor shows comparable efficacy to GP IIb/IIIa I in functional outcomes, with improved reperfusion, suggesting it as a viable alternative during MT procedures. Further randomized controlled trials are needed for comprehensive evaluation.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":"46 9","pages":"1838-1843"},"PeriodicalIF":0.0,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12453470/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144982226","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":"Contrast-Enhanced Brain MRI for Ambulatory Evaluation of Headache: Comprehensive or Excessive?","authors":"Emil J Barkovich, Karen Buch, William A Mehan","doi":"10.3174/ajnr.A8780","DOIUrl":"10.3174/ajnr.A8780","url":null,"abstract":"<p><strong>Background and purpose: </strong>Headache is one of the most common indications for brain MR imaging. Our purpose was to assess the necessity and yield of contrast-enhanced brain MRI protocols relative to noncontrast protocols for the outpatient evaluation of headache in adults.</p><p><strong>Materials and methods: </strong>We retrospectively reviewed 874 consecutive adult outpatient brain contrast-enhanced MRIs for the indication of headache. Examination impressions were reviewed for any findings contributing to headache and stratified into 18 categories. Incidental findings unrelated to headache but mentioned in the report impressions were recorded. A subset of 100 contrast-relevant cases were selected for independent blinded review by 2 neuroradiologists first without contrast and then after a 3-week washout period, with and without contrast. Reviewers were asked to classify cases as positive/negative and to describe relevant findings. Specific diagnoses were compared between reviews and readers on a case-by-case basis. Intrareader agreement was calculated between noncontrast and postcontrast reviews.</p><p><strong>Results: </strong>Eighteen percent of examinations had findings potentially related to headaches. Two percent of cases were deemed contrast relevant. Incidental findings were reported in 4% of cases. On the blinded double review, the percentage of positive cases remained essentially unchanged, decreasing by 1.5% with contrast-enhanced images available. All intra- and extra-axial masses associated with parenchymal edema were detected without contrast. Detection rate of small, incidental meningiomas doubled on postcontrast sequences.</p><p><strong>Conclusions: </strong>Routine acquisition of contrast-enhanced MRIs for outpatients with an indication of headache had a low yield. Noncontrast examinations demonstrated similar sensitivity for actionable intracranial pathology, while contrast-enhanced MRIs doubled the detection rate of incidental meningiomas. A more practical initial approach may be starting with noncontrast examinations with callbacks or additional imaging for a small percentage of patients.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":"46 9","pages":"1780-1785"},"PeriodicalIF":0.0,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12453478/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144982235","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":"Irvin I. Kricheff, 1929-2023.","authors":"Allan J Fox, Jonathan D Clemente, Eric J Russell","doi":"10.3174/ajnr.A8930","DOIUrl":"10.3174/ajnr.A8930","url":null,"abstract":"","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":"1963-1964"},"PeriodicalIF":0.0,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144762642","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":"Evaluation of Spontaneous Intracranial Hypotension Probabilistic Brain MRI Scoring Systems in Normal Patients.","authors":"Crystal H Kang, Ajay A Madhavan, John C Benson, Ian T Mark, Benjamin A Johnson-Tesch, Robert J McDonald, Jared T Verdoorn","doi":"10.3174/ajnr.A8713","DOIUrl":"10.3174/ajnr.A8713","url":null,"abstract":"<p><strong>Background and purpose: </strong>Probabilistic brain MRI scoring systems have been introduced to stratify the likelihood of identifying a CSF leak at myelography in spontaneous intracranial hypotension (SIH). The Bern scoring system by Dobrocky and colleagues is now well recognized, with a scoring system by Benson and colleagues introduced more recently (referred to as the Mayo score in this study). Neither of these scoring systems have been thoroughly evaluated in patients without SIH. The goal of this study was to evaluate these scoring systems in patients without SIH to understand the specificity of these MRI findings.</p><p><strong>Materials and methods: </strong>We retrospectively reviewed normal brain MRIs performed in patients without clinically suspected SIH. Each examination was reviewed by 1 of 4 board-certified neuroradiologists with extensive experience in SIH, and all criteria of both scoring systems were evaluated and recorded.</p><p><strong>Results: </strong>Ninety patients were included. Bern score was low probability in 78% and intermediate probability in 22%. Mayo score was low probability in 100%. Relatively high rates of positivity were seen in 3 specific Bern score parameters, including prepontine cistern effacement 5.0 mm or less (53%), decreased mammilopontine distance 6.5 mm or less (40%), and suprasellar cistern effacement 4.0 mm or less (28%). All intermediate probability Bern scores were due to suprasellar cistern effacement plus either or both prepontine cistern effacement and decreased mammilopontine distance. All other parameters of both scoring systems were either never or very rarely positive.</p><p><strong>Conclusions: </strong>All intermediate probability Bern scores were due to decreased CSF cistern measurements, which had relatively high positivity rates in our non-SIH patient cohort. Due to substantial overlap with normal patients, these measurements are not specific indicators of \"brain sag,\" a hallmark imaging finding for SIH, and are not specific for SIH when the only \"positive\" brain MRI finding(s). The Mayo score is likely more specific for SIH with low probability scores in all patients in our cohort.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":"1925-1930"},"PeriodicalIF":0.0,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12453467/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143469916","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":"Advanced Application of \"Blank Roadmap\" Technique for Transvenous Approach.","authors":"Mohamad Izzat Arslan Che Ros, Ryuichi Noda, Suzana Saleme, Aymeric Rouchaud, Charbel Mounayer","doi":"10.3174/ajnr.A8905","DOIUrl":"10.3174/ajnr.A8905","url":null,"abstract":"<p><p>The \"blank roadmap\" technique has been used to access occluded inferior petrosal sinus, which is not visualized on the venous phase of an angiogram. In this video article, we applied this technique to navigate the guidewire/microcatheter through the torcula and cavernous sinus. Torcula and cavernous sinus are a \"carrefour\" of veins and sinuses, with highly variable anatomic area and complex structure. They can serve as an access relay to distal targets in transvenous embolization during treatment of dural AVF or brain AVM, allowing access to the contralateral side. However, navigating a catheter device through these complex structures, which are not always clearly visible on venography, is challenging. We describe the advanced application of the \"blank roadmap\" technique for challenging cases of transvenous embolization for dural AVF and brain AVM.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":"1851"},"PeriodicalIF":0.0,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12453487/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144762640","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":"Interobserver and Intraobserver Variability in the Assessment of Prolonged Venous Transit in Anterior Circulation Large-Vessel Occlusion Ischemic Stroke.","authors":"Hamza Adel Salim, Maggie Barghash, Dhairya A Lakhani, Aneri Balar, Janet Mei, Jee Moon, Cynthia Greene, Licia Luna, Nathan Z Hyson, Francis Deng, Adam A Dmytriw, Adrien Guenego, Elisabeth B Marsh, Hanzhang Lu, Risheng Xu, Rich Leigh, Gaurang Shah, Gregory W Albers, Argye E Hillis, Rafael Llinas, Kambiz Nael, Max Wintermark, Jeremy J Heit, Tobias D Faizy, Vivek Yedavalli","doi":"10.3174/ajnr.A8778","DOIUrl":"10.3174/ajnr.A8778","url":null,"abstract":"<p><strong>Background and purpose: </strong>Prolonged venous transit (PVT) on time-to-maximum (Tmax) perfusion maps has been associated with worse outcomes in patients with acute ischemic stroke due to anterior circulation large-vessel occlusion (AIS-LVO). The qualitative nature of PVT assessment introduces potential variability, and its reproducibility has not been systematically evaluated.</p><p><strong>Materials and methods: </strong>In a retrospective study of patients with confirmed AIS-LVO, 2 board-certified neuroradiologists independently reviewed pretreatment Tmax maps to assess PVT in the posterior superior sagittal sinus and torcula. One reader repeated the assessment after 24 weeks at minimum. Interobserver and intraobserver variability were evaluated with Cohen unweighted κ coefficients.</p><p><strong>Results: </strong>Among 194 patients, median age was 70 years (interquartile range, 62-79), and 57% were women. Interobserver agreement was substantial (κ = 0.79; 95% CI, 0.69-0.88), reflecting concordant classification in 178 of 194 patients. Intraobserver agreement was also strong (κ = 0.87; 95% CI, 0.79-0.94), with initial and repeat evaluations differing in 11 cases.</p><p><strong>Conclusions: </strong>Qualitative PVT assessment demonstrated substantial interobserver and almost perfect intraobserver reliability. These findings support the use of PVT as a consistent marker of impaired venous outflow in AIS-LVO. Future studies should explore automated or semiquantitative methods to further improve reproducibility and enhance clinical utility.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":"46 9","pages":"1800-1804"},"PeriodicalIF":0.0,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12453461/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144982163","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":"Evaluation of Stapes Image Quality with Ultra-High-Resolution CT in Comparison with Conebeam CT and High-Resolution CT in Cadaveric Heads.","authors":"Ulysse Puel, Sara Boukhzer, Mathieu Doyen, Gabriela Hossu, Fatma Boubaker, Groubatch Frédérique, Alain Blum, Pedro Augusto Gondim Teixeira, Michael Eliezer, Cécile Parietti-Winkler, Romain Gillet","doi":"10.3174/ajnr.A8748","DOIUrl":"10.3174/ajnr.A8748","url":null,"abstract":"<p><strong>Background and purpose: </strong>Conventional CT imaging techniques are ineffective in adequately depicting the stapes. The purpose of this study was to evaluate the ability of high-resolution (HR), ultra-high-resolution (UHR) with and without deep learning reconstruction (DLR), and conebeam (CB)-CT scanners to image the stapes by using micro-CT as a reference.</p><p><strong>Materials and methods: </strong>Eleven temporal bone specimens were imaged by using all imaging modalities. Subjective image analysis was performed by grading image quality on a Likert scale, and objective image analysis was performed by taking various measurements of the stapes superstructure and footplate. Image noise and radiation dose were also recorded.</p><p><strong>Results: </strong>The global image quality scores were all worse than micro-CT (<i>P</i> ≤ .01). UHR-CT with and without DLR had the second-best global image quality scores (<i>P</i> > .99), which were both better than CB-CT (<i>P</i> = .01 for both). CB-CT had a better global image quality score than HR-CT (<i>P</i> = .01). Most of the measurements differed between HR-CT and micro-CT (<i>P</i> ≤ .02), but not between UHR-CT with and without DLR, CB-CT, and micro-CT (<i>P</i> > .06). The air noise value of UHR-CT with DLR was not different from CB-CT (<i>P</i> = .49), but HR-CT and UHR-CT without DLR exhibited higher values than UHR-CT with DLR (<i>P</i> ≤ .001). HR-CT and UHR-CT with and without DLR yielded the same effective radiation dose values of 1.23 ± 0.11 (1.13-1.35) mSv, which was 4 times higher than that of CB-CT (0.35 ± 0 mSv, <i>P</i> ≤ .01).</p><p><strong>Conclusions: </strong>UHR-CT with and without DLR offers comparable objective image analysis to CB-CT while providing superior subjective image quality. However, this is achieved at the cost of a higher radiation dose. Both CB-CT and UHR-CT with and without DLR are more effective than HR-CT in objective and subjective image analysis.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":"1900-1907"},"PeriodicalIF":0.0,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12453474/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143702437","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-Term (12 Months) Outcomes of Endovascular Thrombectomy for Large Core Stroke: A Meta-Analysis of SELECT2, TESLA, TENSION, and LASTE Trials.","authors":"Ali Mortezaei, Muhammed Amir Essibayi, Ahmed Abdelsalam, Joshua Hanna, Redi Rahmani, David J Altschul, Robert M Starke","doi":"10.3174/ajnr.A8749","DOIUrl":"10.3174/ajnr.A8749","url":null,"abstract":"<p><strong>Background: </strong>Endovascular thrombectomy (EVT) has demonstrated benefits over standard medical care (MC) in randomized controlled trials (RCTs) for patients with large vessel occlusion (LVO) and large infarct territory at 90 days. However, conflicting evidence exists regarding long-term safety and efficacy of EVT in these populations.</p><p><strong>Purpose: </strong>To evaluate the clinical benefits of EVT in patients with large-core infarction through meta-analysis of high-quality RCT evidence with up to one-year follow-up.</p><p><strong>Data sources: </strong>PubMed/MEDLINE, Web of Science, and Scopus databases.</p><p><strong>Study selection: </strong>RCTs involving patients with confirmed LVO and Alberta Stroke Program Early CT Score (Alberta Stroke Program Early CT Score [ASPECTS]) of ≤5, comparing EVT plus MC versus MC alone, with long-term outcome data.</p><p><strong>Data analysis: </strong>Meta-analysis of long-term functional and safety outcomes with subgroup analysis comparing long-term (≤1 year) versus short-term (≤90 days) data on functional outcomes, imaging modalities, and presentation window. Leave-one-out sensitivity analysis was performed to resolve heterogeneity.</p><p><strong>Data synthesis: </strong>Four RCTs comprising 1229 patients (49% female) were included. EVT demonstrated significant superiority over MC in functional independence (modified Rankin Scale [mRS] 0-2) (RR 3.91, 95% CI 2.7-5.66; <i>P</i><0.001), mortality (RR 0.84, 95% CI 0.75-0.95; <i>P</i> = 0.005), overall survival (mRS0-5) (RR 1.17, 95% CI 1.05-1.31; <i>P</i> = 0.005), and quality of life (SMD 0.55, 95% CI 0.32-0.8; <i>P</i><0.001) with up to one-year follow-up. No significant differences in complication rates were observed except for higher extra-cerebral thromboembolic events in the EVT group (RR 7.94, 95% CI 1.01-62.2; <i>P</i> = 0.048).</p><p><strong>Limitations: </strong>Study limited to RCT data with potential variations in thrombectomy techniques and patient selection criteria across trials.</p><p><strong>Conclusions: </strong>In patients with ischemic stroke due to LVO with established large core infarct, EVT plus MC showed significant long-term benefits in functional outcomes, survival, and quality of life compared to MC alone.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":"1830-1837"},"PeriodicalIF":0.0,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12453471/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143733550","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}