AJNR. American journal of neuroradiology最新文献

{"title":"Patient and Provider Characteristics Associated with the Receipt of Image-Guided Interventions for Low Back Pain.","authors":"Ghazaleh Safazadeh, Ruth C Carlos, Lubdha M Shah, Gregory J Stoddard, Rebecca Steed, Troy A Hutchins, Miriam E Peckham","doi":"10.3174/ajnr.A8502","DOIUrl":"10.3174/ajnr.A8502","url":null,"abstract":"<p><strong>Background and purpose: </strong>Low back pain (LBP) commonly causes disability, often managed with conservative image-guided interventions before surgery. Research has documented racial disparities with these and other nonpharmacologic treatments. We posited that individual chart reviews may provide insight into the disparity of care types through documented patient/provider discussions and their effect on treatment plans.</p><p><strong>Materials and methods: </strong>This retrospective analysis involved adults newly diagnosed with LBP in a large Utah health care system. The primary outcome was the association of provider and patient variables with the frequency of image-guided interventions received within 1 year of LBP diagnosis between White/non-Hispanic and underrepresented minority cohorts. Secondary outcomes were receipt of additional treatment types (physical therapy and lumbar surgery), time to any treatment, time to image-guided intervention, and discussion/receipt of therapy between cohorts within 1 year of diagnosis.</p><p><strong>Results: </strong>Among 812 subjects (59% White/non-Hispanic and 41% underrepresented minority), more White/non-Hispanic patients had at least 1 image-guided intervention within 12 months compared with underrepresented minority patients (12.5% versus 7.2%, <i>P</i> = .01), despite underrepresented minorities having higher presenting pain scores (64.5% versus 49.3%; pain intensity, >5; <i>P</i> = .001). Underrepresented minority patients more often saw generalists (71.7% versus 52.6%, <i>P</i> < .001) and advanced practice clinician providers (33.6% versus 25.6%, <i>P</i> < .02) compared with the White/non-Hispanic cohort. Both cohorts were referred to a specialist at the same rate (17.7% versus 19.8%, <i>P</i> = .20); however, referral completion was noted less often (60.4% versus 77.7%, <i>P</i> = .02) and took longer to complete in underrepresented minority patients (mean, 54 versus 27.5 days; <i>P</i> = .003).</p><p><strong>Conclusions: </strong>Underrepresented minority patients had more severe LBP on presentation but received image-guided interventions less often than White/non-Hispanic patients. Our in-depth chart analysis supports the lack of referral completion and evaluation from a spine specialist provider as the main deterrent to the receipt of image-guided interventions in this cohort. While there may be systematic provider barriers such as an absence of decision-making discussion, data do not support provider bias as a contributing factor to differences in receipt of image-guided interventions.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":"589-596"},"PeriodicalIF":0.0,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142303161","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":"Diffusion- and Tractography-Based Characterization of Tissue Damage Within and Surrounding Paramagnetic Rim Lesions in Multiple Sclerosis.","authors":"Maryam Mohebbi, Jack A Reeves, Dejan Jakimovski, Alexander Bartnik, Niels Bergsland, Fahad Salman, Ferdinand Schweser, Bianca Weinstock-Guttman, Robert Zivadinov, Michael G Dwyer","doi":"10.3174/ajnr.A8524","DOIUrl":"https://doi.org/10.3174/ajnr.A8524","url":null,"abstract":"<p><strong>Background and purpose: </strong>Paramagnetic rim lesions (PRLs) are an imaging biomarker of chronic inflammation in MS that are associated with more aggressive disease. However, the precise tissue characteristics and extent of their damage, particularly with regard to connected axonal tracts, are incompletely understood. Quantitative diffusion tissue measurements and fiber tractography can provide a more complete picture of these phenomena.</p><p><strong>Materials and methods: </strong>One hundred fifteen people with MS were enrolled in this study. Quantitative susceptibility mapping and DWI were acquired on a 3T MRI scanner. PRLs were identified in 49 (43%) subjects. Diffusion tractography was then used to identify nearby PRL-connected versus non-PRL connected tracts and PRL-connected versus nonconnected surrounding tracts. DWI metrics, including fractional anisotropy (FA), quantitative anisotropy (QA), mean diffusivity, axial diffusivity, radial diffusivity, isotropy, and restricted diffusion imaging, were compared between these tracts and within PRLs and non-PRL lesions themselves.</p><p><strong>Results: </strong>Tissue within PRLs had significantly lower FA than tissue within non-PRL T2 lesions (<i>P</i> = .04). Tracts connected to PRLs exhibited significantly lower FA (<i>P</i> < .001), higher restricted diffusion imaging (<i>P</i> = .02, and higher Iso values (<i>P</i> = .007) than tracts connected to non-PRL T2 lesions. Only QA was different between tracts connected to PRLs and nonconnected surrounding tracts (<i>P</i> = .003).</p><p><strong>Conclusions: </strong>PRLs are more destructive both within themselves and to surrounding tissue. This damage appears more spatially than axonally mediated.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":"46 3","pages":"611-619"},"PeriodicalIF":0.0,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143559432","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":"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 Daz 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":"https://doi.org/10.3174/ajnr.A8719","url":null,"abstract":"<p><strong>Background and purpose: </strong>Unruptured intracranial aneurysms are pathological bulging of the arterial walls that could rupture and cause subarachnoid hemorrhage. Recently, stents with modified surfaces have been used as treatment for intracranial aneurysms. 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 intracranial aneurysms in 546 patients. At 12 months, overall adequate O'Kelly-Marotta grading scale (OKM=C-D) angiographic results was 83%. For the PEDV stent was 97% and for the PED-Shield stent 80% (p=<0.001). Mortality (0.9%, p=0.34) and overall morbidity 0.5% (PEDV 0.3% and 0.2% PED-Shield). Overall complications events were 3.1%, thromboembolic events were 2.1% in the PED-Shield stent, and 6.7% in the PEDV stent (p=0.008). (p=0.34) Overall bleeding complications were 1.7%, in the PED-Shield stent (0.9%) and two 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><p><strong>Abbreviations: </strong>ICA= Internal carotid artery; AcomA= Anterior communicating artery; ACA= Anterior cerebral artery; PCA= Posterior cerebral artery; aSAH= Aneurysmal subarachnoid hemorrhage; FDS= flow-diverting stents; IA= Intracranial aneurysm; PEDV= Pipeline Vantage Embolization Device with Shield Technology; PED-Shield= Pipeline Flex Embolization Device with Shield Technology; DAPT= Dual antiplatelet therapy; PcomA= Posterior communicating artery.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143506693","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":"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":"https://doi.org/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 cerebrospinal fluid (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, 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 using blood, fibrin, or both, and immediate post-patch 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% female) with 44 spinal levels patched: cervical (6.8%), thoracic (68.2%), and lumbar (25%). Mean patch volume (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, p = 0.001). Patches in the cervical region demonstrated the highest CC spread efficiency (0.77 levels/mL) compared to thoracic (0.56 levels/mL) and lumbar patches (0.47 levels/mL; p < 0.01). DI injections achieved greater CC spread but less VE dispersion than TFO injections (5.0 vs. 3.2 levels; p = 0.02; 58.8% vs 70.0%, p = 0.52). VE spread occurred in 61.4% of cases and followed a non-linear 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 craniocaudal spread but reduce ventral dispersion.</p><p><strong>Abbreviations: </strong>CSF = cerebrospinal fluid; CC = craniocaudal; VE = ventral epidural; DI = dorsal interlaminar; TFO = transforaminal.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143506701","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 Ultrasound in Neck Node NIRADS 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":"https://doi.org/10.3174/ajnr.A8717","url":null,"abstract":"<p><strong>Background and purpose: </strong>The NI-RADS scoring system standardized imaging surveillance of head and neck (H&N) cancer with risk classification. A nodal NIRADS 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 are recommended. The unclear follow-up imaging findings and/or mild FDG uptake raise patient's anxiety of potential delay in diagnosis and intervention while adding high imaging cost. Therefore, at our institution, diagnostic US/US-guided fine needle aspiration (US-FNA) is incorporated in our paradigm. We aim to evaluate US performance in nodal NI-RADS 2 on CECT as 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 CECT neck, and a neck US/US-FNA performed within 3 months afterwards for evaluation of the NI-RADS 2 node. We categorized US/US-guided 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. 18 (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. 2 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 NIRADS 2, surpassing the published rate of 14.3%. The sensitivity, accuracy and NPV 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><p><strong>Abbreviations: </strong>CECT = contrast-enhanced CT; CEMR = contrast-enhanced MR; ENE = extranodal extension; FNA = fine-needle aspiration; NI-RADS = Neck Imaging Reporting and Data System; NPV = negative predictive value; PPV = positive predictive value; SCC = squamous cell carcinoma; RVU = relative value units; US = ultrasound.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143494904","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":"Comparison of prophylactic endovascular treatments for threatened or impending internal/common carotid artery blowout syndrome.","authors":"Han-Yi Yen, Yen-Heng Lin, Ya-Fang Chen, Jia-Zheng Huang, Pin-Chen Chen, Chung-Wei Lee, Bo-Ching Lee","doi":"10.3174/ajnr.A8716","DOIUrl":"https://doi.org/10.3174/ajnr.A8716","url":null,"abstract":"<p><strong>Background and purpose: </strong>The outcomes of prophylactic endovascular interventions for patients facing threatened or impending carotid blowout syndrome (CBS) involving the internal/common carotid artery (ICA/CCA) have not been extensively elucidated. We aimed to delineate the specific treatment outcomes for this group of patients.</p><p><strong>Materials and methods: </strong>We retrospectively enrolled 109 patients with threatened or impending CBS of the ICA/CCA between 2006 and 2023. Patients were categorized into Group 1 (no intervention for ICA/CCA, n=43), Group 2 (ICA/CCA embolization, n=36), or Group 3 (ICA/CCA stenting, n=30). ANOVA and Cox regression analyses were employed to evaluate basic characteristics and the rates of recurrent bleeding, overall survival, and major complications.</p><p><strong>Results: </strong>Age (56.8 ± 8.7 vs. 54.3 ± 11.6 vs. 56.6 ± 9.2), male sex (39/43 vs. 33/36 vs. 26/30), tumor size, and type of blowout were similar (P>0.05) among groups. Tumor location (P<0.001) and presence of air-containing necrosis on CT/MRI before trans-arterial embolization (P=0.001) varied between groups. Cox regression analysis adjusted for age and sex revealed Group 2 had a lower risk of recurrent bleeding than Group 1 (adjusted hazard ratio (HR), 0.22; 95% CI, 0.10-0.47; P<0.001) and Group 3 (0.41; 95% CI, 0.170.96; P=0.042), but a higher risk of acute stroke (P=0.016). Group 2 had higher overall survival than Groups 1 and 3 (0.55; 95% CI, 0.31-0.96; P=0.036).</p><p><strong>Conclusions: </strong>In threatened or impending CBS of the ICA/CCA, prophylactic embolization was associated with a lower risk of recurrent bleeding but a higher risk of acute stroke compared to ICA/CCA stenting or no intervention.</p><p><strong>Abbreviations: </strong>BTO = balloon test occlusion; CBS = carotid blowout syndrome; CCA = common carotid artery; ECA = external carotid artery; HR = hazard ratio; ICA = internal carotid artery; TAE = trans-arterial embolization.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143494896","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":"The effect of diagnostic hypercapnic cerebrovascular reactivity imaging on vital signs and acute and follow-up ischemic adverse events in patients with flow-limiting intracranial arterial stenosis.","authors":"Melanie Leguizamon, Caleb Han, Maria Garza, Mackenzie Horne, Wesley T Richerson, L Taylor Davis, Dann Martin, Matthew Fusco, Rohan Chitale, Lori C Jordan, Manus J Donahue","doi":"10.3174/ajnr.A8714","DOIUrl":"10.3174/ajnr.A8714","url":null,"abstract":"<p><strong>Background and purpose: </strong>Anatomical imaging is a hallmark for visualizing chronic and acute infarcts but provides incomplete information on stroke risk. Respiratory hypercapnic gas challenges show promise for non-invasively assessing hemodynamic function and mapping cerebrovascular reserve capacity, an indicator of how near parenchyma is to exhausting autoregulatory capacity. However, limited safety information exists for this method in high-risk patients with flow-limiting stenosis. This study reports on the physiological changes and adverse events (AEs) following diagnostic hypercapnic cerebrovascular reactivity imaging assessments.</p><p><strong>Materials and methods: </strong>Between January 2011 and May 2024, reactivity scans were performed on 262 patients. In patients with flow-limiting intracranial arterial steno-occlusion (>70%), vital signs were assessed during a twice-repeated three-minute fixed-inspired 5%CO2/95%O2 stimulus, and acute (0-24 hours), sub-acute (24 hours - 2 months), and longer-term (2 - 12 months) AEs were recorded.</p><p><strong>Results: </strong>129 patients met criteria for flow-limiting arterial steno-occlusion. Blood pressure did not change (p>0.40) with hypercapnia. EtCO₂ (baseline:36.5±4.5 mmHg, hypercapnia:42.5±3.8 mmHg) and SaO₂ (baseline:97.5±1.8%, hypercapnia:99.4±0.8%) increased (p<0.001), paralleling hypercapnic-hyperoxic physiology. No acute ischemic adverse events were noted. One sub-acute and four long-term neurological events were noted, within expected range for this population.</p><p><strong>Conclusions: </strong>Findings support using hypercapnic reactivity mapping in the setting of flow-limiting cerebrovascular disease.</p><p><strong>Abbreviations: </strong>CVR = cerebrovascular reactivity, MRI = magnetic resonance imaging, EtCO₂ = end-tidal carbon dioxide, SaO₂ = arterial oxygen saturation, BOLD = blood oxygenation level-dependent, AE = adverse event, SAE = serious adverse event.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143494872","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":"External Validation of a Winning AI-Algorithm from the RSNA 2022 Cervical Spine Fracture Detection Challenge.","authors":"James P Harper, Ghee R Lee, Ian Pan, Xuan V Nguyen, Nathan Quails, Luciano M Prevedello","doi":"10.3174/ajnr.A8715","DOIUrl":"https://doi.org/10.3174/ajnr.A8715","url":null,"abstract":"<p><strong>Background and purpose: </strong>The Radiological Society of North America has actively promoted artificial intelligence (AI) challenges since 2017. Algorithms emerging from the recent RSNA 2022 Cervical Spine Fracture Detection Challenge demonstrated state-of-theart performance in the competition's dataset, surpassing results from prior publications. However, their performance in real-world clinical practice is not known. As an initial step towards the goal of assessing feasibility of these models in clinical practice, we conducted a generalizability test using one of the leading algorithms of the competition.</p><p><strong>Materials and methods: </strong>The deep learning algorithm was selected due to its performance, portability and ease of use and installed locally. 100 examinations (50 consecutive cervical spine CT scans with at least one fracture present and 50 consecutive negative CT scans) from a Level 1 trauma center not represented in the competition dataset were processed at 6.4s per exam. Ground truth was established based on the radiology report with retrospective confirmation of positive fracture cases. Sensitivity, specificity, F1 score, and AUC were calculated.</p><p><strong>Results: </strong>The external validation dataset was comprised of older patients in comparison to the competition set (53.5 ± 21.8 years vs 58 ± 22.0 respectively; p < .05). Sensitivity and specificity were 86% and 70% in the external validation group and 85% and 94% in the competition group, respectively. Fractures misclassified by the CNN frequently had features of advanced degenerative disease, subtle nondisplaced fractures not easily identified on the axial plane, and malalignment.</p><p><strong>Conclusions: </strong>The model performed with a similar sensitivity on the test and external dataset, suggesting that such a tool could be potentially generalizable as a triage tool in the emergency setting. Discordant factors such as age-associated comorbidities may affect accuracy and specificity of AI models when used in certain populations. Further research should be encouraged to help elucidate the potential contributions and pitfalls of these algorithms in supporting clinical care.</p><p><strong>Abbreviations: </strong>AI= artificial intelligence; CNN = convolutional neural networks; RSNA= Radiological Society of North America.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143494924","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":"Impact of Smoking on Recurrence and Angiographic Outcomes After Endovascular Treatment of Intracranial Aneurysms: A Systematic Review and Meta-Analysis.","authors":"Sherief Ghozy, Seyed Behnam Jazayeri, Alireza Hasanzadeh, Julien Ognard, Hassan Kobeissi, Ali Ahmadzade, Ehsan Naseh, Mobina Motaghian Fard, Alzhraa S Abbas, Rachana R Borkar, David F Kallmes, Ramanathan Kadirvel","doi":"10.3174/ajnr.A8712","DOIUrl":"https://doi.org/10.3174/ajnr.A8712","url":null,"abstract":"<p><strong>Background: </strong>Cerebral aneurysm recurrence serves as a significant endpoint for assessing the efficacy of various endovascular treatment strategies. The impact of smoking on outcomes such as aneurysm occlusion, recurrence, and recanalization remains unclear due to conflicting evidence.</p><p><strong>Purpose: </strong>To systematically evaluate the role of smoking in influencing angiographic outcomes following endovascular treatment of intracranial aneurysms.</p><p><strong>Data sources: </strong>Comprehensive searches were conducted in PubMed, Embase, Scopus, and Web of Science STUDY SELECTION: This systematic review and meta-analysis followed PRISMA guidelines to identify relevant studies assessing smoking's impact on intracranial aneurysms following endovascular treatment.</p><p><strong>Data analysis: </strong>Studies were screened, selected, and assessed for risk of bias using appropriate checklists. Data on complete and adequate aneurysm occlusion, and recurrence/recanalization rates were extracted. Random-effects meta-analyses calculated risk ratios (ORs) with 95% confidence intervals (CIs). Heterogeneity was measured using the I² statistic.</p><p><strong>Data synthesis: </strong>A total of 26 studies, encompassing 6,031 patients, met the inclusion criteria. Smokers had higher rates of complete aneurysm occlusion (RR 1.12, 95% CI 1.06-1.19; p < 0.01). Subgroup analysis revealed that smokers undergoing flow diversion exhibited a higher rate of complete occlusion (RR 1.14, 95% CI 1.07-1.21; p < 0.01). However, for patients undergoing coiling, there was no significant difference in complete occlusion rates between smokers and non-smokers (RR 1.00, 95% CI 0.83- 1.20; p = 0.46). Recurrence/recanalization rates were similar between smokers and non-smokers: RR 1.17, 95% CI 0.93-1.47; p = 0.20, and the rate of aneurysm retreatment did not differ between the smokers and non-smokers: RR 0.82, 95% CI 0.59-1.13; p =0.23.</p><p><strong>Limitations: </strong>Heterogeneity in definitions of smoking status, variations in follow-up durations, short follow up, retrospective nature of studies.</p><p><strong>Conclusions: </strong>Smoking status does not significantly impact aneurysm recanalization or retreatment after endovascular repair. However, the impact of smoking on complete occlusion rate might differ based on the type of device used for treatment. Histological and molecular factors may contribute to varied outcomes, highlighting the necessity for further research to understand smoking's role in aneurysm healing. Clinically, patients should be advised about the risks of smoking, though current evidence suggests that smoking cessation may not consistently affect treatment efficacy.</p><p><strong>Abbreviations: </strong>sAH = subarachnoid hemorrhage; RROC = Raymond-Roy occlusion classification.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143473244","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":"https://doi.org/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 et al. is now well recognized, with a scoring system by Benson et al. 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 one of four board-certified neuroradiologists with extensive experience in SIH, and all criteria of both scoring systems were evaluated and recorded.</p><p><strong>Results: </strong>90 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 three 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 normals, 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><p><strong>Abbreviations: </strong>SIH, spontaneous intracranial hypotension; DSM, digital subtraction myelography; CTM, CT myelography; PC-CTM, photon counting CT myelography; CVF, CSF-venous fistula; ICC, intraclass correlation coefficient.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143469916","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}