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  • Cerebrofacial venous metameric syndrome—spectrum of imaging findings
    Neuroradiology (IF 2.504) Pub Date : 2020-01-14
    Waleed Brinjikji, Patrick Nicholson, Christopher A Hilditch, Timo Krings, Vitor Pereira, Ronit Agid

    Cerebrofacial venous metameric syndrome (CVMS) is a complex craniofacial vascular malformation disorder in which patients have a constellation of venous vascular malformations affecting soft tissues, bone, dura, and neural structures including the eye and brain. It is hypothesized that a somatic mutation responsible for the venous abnormalities occurred prior to migration of the neural crest cells, and because of this, facial, osseous, and cerebral involvement typically follows a segmental or “metameric” distribution. The most commonly recognized form of CVMS is Sturge-Weber syndrome. However, a wide spectrum of CVMS phenotypical presentations exist with various metameric distributions of slow-flow vascular lesions including facial venous vascular malformations, developmental venous anomalies, venous angiomas, cavernous malformations (cavernomas), dural sinus malformations, and maybe even vascular tumors such as cavernous hemangiomas. Awareness of the various manifestations as described herewith is important for treatment and screening purposes.

    更新日期:2020-01-14
  • Rescue stenting versus medical care alone in refractory large vessel occlusions: a systematic review and meta-analysis
    Neuroradiology (IF 2.504) Pub Date : 2020-01-11
    Kévin Premat, Agnes Dechartres, Stéphanie Lenck, Eimad Shotar, Raphaël Le Bouc, Vincent Degos, Nader Sourour, Sonia Alamowitch, Yves Samson, Frédéric Clarençon

    Mechanical thrombectomy (MT) failure is associated with very poor prognosis. Permanent intracranial stenting (PIS) may be useful in such refractory occlusions. However, this strategy requires an aggressive antithrombotic regimen that may be harmful in extended strokes. The aim of this study was to compare clinical outcomes between patients with refractory acute large vessel occlusions (LVOs) treated by PIS versus patients for whom the procedure was stopped without recanalization.

    更新日期:2020-01-13
  • Brain miliary enhancement
    Neuroradiology (IF 2.504) Pub Date : 2020-01-10
    Joseph C.J. Bot, Linda Mazzai, Rogier E. Hagenbeek, Silvia Ingala, Bob van Oosten, Esther Sanchez-Aliaga, Frederik Barkhof

    Abstract Purpose Miliary enhancement refers to the presence of multiple small, monomorphic, enhancing foci on T1-weighted post-contrast MRI images. In the absence of a clear clinical presentation, a broad differential diagnosis may result in invasive procedures and possibly brain biopsy for diagnostic purposes. Methods An extensive review of the literature is provided for diseases that may present with miliary enhancement on T1-weighted brain MR images. Additional disease-specific findings, both clinical and radiological, are summarized and categorized by the presence or absence of perivascular space involvement. Results Miliary pattern of enhancement may be due to a variety of underlying causes, including inflammatory, infectious, nutritional or neoplastic processes. The recognition of disease spread along the perivascular spaces in addition to the detection or exclusion of disease-specific features on MRI images, such as leptomeningeal enhancement, presence of haemorrhagic lesions, spinal cord involvement and specific localisation or systemic involvement, allows to narrow the potential differential diagnoses. Conclusion A systematic approach to disease-specific findings from both clinical and radiological perspectives might facilitate diagnostic work-up, and recognition of disease spread along the perivascular spaces may help narrowing down differential diagnoses and may help to minimize the use of invasive diagnostic procedures.

    更新日期:2020-01-11
  • Tumor T2 signal intensity and stalk angulation correlates with endocrine status in pituitary adenoma patients: a quantitative 7 tesla MRI study
    Neuroradiology (IF 2.504) Pub Date : 2020-01-10
    John W. Rutland, Puneet Pawha, Puneet Belani, Bradley N. Delman, Corey M. Gill, Teresa Brown, Khadeen Cheesman, Raj K. Shrivastava, Priti Balchandani

    Abstract Purpose Pituitary adenomas are common CNS tumors that can cause endocrine dysfunction due to hormone oversecretion and by mass effect on the normal gland. The study of pituitary adenomas and adjacent sellar anatomy with high-resolution 7 T MRI may further characterize endocrine dysfunction. The purpose of this study was to determine the efficacy of 7 T MRI in identifying radiological markers for endocrine function. Methods MR images obtained in 23 patients with pituitary adenomas were reviewed by consensus between three neuroradiologists. Landmarks and criteria were devised to measure radiological features of stalk, tumor, and normal gland. Fischer’s exact tests and nominal logistic regression were performed. Results Mean cross-sectional area of the stalk just below the infundibular recess was 6.3 ± 3.7 mm2. Mean curvature and deviation angles were 34.2° ± 23.2° and 29.7° ± 17.3°, respectively. Knosp scores obtained differed between 7 T and lower field strength scans (P < 0.0001 [right] and P = 0.0006 [left]). Ability to characterize tumor was rated higher at 7 T compared with lower field MRI, P = 0.05. Confidence in visualizing normal gland was also higher using 7 T MRI, P = 0.036. The six hormone-secreting tumors had higher corrected T2 mean SI than non-secreting tumors (2.54 vs. − 0.38, P = 0.0196). Seven patients had preoperative hypopituitarism and had significantly greater stalk curvature angles than patients without hypopituitarism (71.7° vs. 36.55°, P = 0.027). Conclusion Radiological characterization of pituitary adenomas and adjacent native pituitary tissue may benefit with the use of 7 T MRI. Corrected T2 SI of tumor may be a sensitive predictor of hormonal secretion and may be useful in the diagnostic work-up for pituitary adenoma. Summary statement 7 T MRI may be valuable in identifying markers of endocrine function in patients with pituitary adenomas. Our results indicate that hormone-secreting tumors have higher T2-weighted SI and tumors associated with preoperative hypopituitarism have greater stalk curvature angles.

    更新日期:2020-01-11
  • Are hemodynamics of irregular small carotid-ophthalmic aneurysms different from those of regular ones and large aneurysms based on numerical simulation?
    Neuroradiology (IF 2.504) Pub Date : 2020-01-10
    Hailin Wan, Lei Huang, Liang Ge, Yeqing Jiang, Gaohui Li, Xiaochang Leng, Xiaoyuan Feng, Jianping Xiang, Xiaolong Zhang

    The purpose of this study is to investigate whether hemodynamics of unruptured, irregular small intracranial aneurysms (SIAs) are different from those of regular ones and large intracranial aneurysms (LIAs) in ophthalmic artery segment of internal carotid artery (ICA).

    更新日期:2020-01-11
  • Arterial spin labeling imaging correlates with the angiographic and clinical vascularity of vestibular schwannomas
    Neuroradiology (IF 2.504) Pub Date : 2020-01-09
    Yujiro Tanaka, Michihiro Kohno, Takao Hashimoto, Nobuyuki Nakajima, Hitoshi Izawa, Hirofumi Okada, Norio Ichimasu, Ken Matsushima, Tomoya Yokoyama

    Hypervascular vestibular schwannomas (HVSs) are a type of the vestibular schwannomas (VSs) that are extremely difficult to remove. We examined whether HVSs can be predicted by using arterial spin labeling (ASL) imaging.

    更新日期:2020-01-09
  • Safety and efficacy of staged angioplasty for patients at risk of hyperperfusion syndrome: a single-center retrospective study
    Neuroradiology (IF 2.504) Pub Date : 2020-01-08
    Satoshi Murai, Kenji Sugiu, Tomohito Hishikawa, Masafumi Hiramatsu, Shingo Nishihiro, Naoya Kidani, Yu Takahashi, Kazuhiko Nishi, Yoko Yamaoka, Isao Date

    Intracranial hemorrhage following hyperperfusion syndrome (HPS) is a rare but potentially fatal complication after carotid artery stenting (CAS). Staged angioplasty (SAP) is a two-stage form of CAS that can prevent the abrupt increase of cerebral blood flow. In this study, we investigated the safety and efficacy of SAP.

    更新日期:2020-01-08
  • Correction to: Cerebral aneurysm in a giant perivascular space
    Neuroradiology (IF 2.504) Pub Date : 2020-01-06
    Dylan Henssen, Frederick Meijer

    The above article was published online with incorrect spelling of author name. The published online paper states “Frederik Meijer”, whereas it should be “Frederick Meijer”. The surname has been corrected above. The original article has been corrected.

    更新日期:2020-01-06
  • Is four-dimensional CT angiography as effective as digital subtraction angiography in the detection of the underlying causes of intracerebral haemorrhage: a systematic review
    Neuroradiology (IF 2.504) Pub Date : 2020-01-04
    C. E. Denby, K. Chatterjee, R. Pullicino, S. Lane, M. R. Radon, K. V. Das

    Abstract Purpose To determine whether the sensitivity and specificity of four-dimensional CTA (4D-CTA) are equivalent to digital subtraction angiography (DSA) in the detection of underlying vascular abnormalities in patients with intracerebral haemorrhage (ICH). Methods A systematic review of studies comparing 4D-CTA with DSA in the detection of the underlying structural causes of ICH was performed on the literature published between 1998 and 2019. Results We identified a total of 237 articles from PubMed, SCOPUS and Web of Science using the following Medical Subject Headings (MeSH) terms: primary intracerebral haemorrhage, 4D-CTA, DSA, cerebral haemorrhage, angiography, digital subtraction, arteriovenous malformations, 4D, CTA, dynamic-CTA and time-resolved CTA. Following the removal of duplicate publications and articles failing to meet our inclusion criteria, there were four articles potentially viable for analysis. Therefore, there were not sufficient studies to provide a statistically meaningful meta-analysis. Conclusion The review of current literature has demonstrated that there are few published studies comparing 4D-CTA with DSA in spontaneous ICH, with only four suitable studies identified for potential analysis. However, due to the restricted number of patients and high sensitivity and specificity of 3 studies (100%), performing a meta-analysis was not meaningful. Qualitative analysis of the data concluded that 4D-CTA has the diagnostic potential to replace invasive DSA in certain cases with vascular abnormalities. However, further research studies directly comparing 4D-CTA with DSA using larger prospective patient cohorts are required to strengthen the evidence base.

    更新日期:2020-01-04
  • Comparison of multimodal CT scan protocols used for decision-making on mechanical thrombectomy in acute ischemic stroke
    Neuroradiology (IF 2.504) Pub Date : 2020-01-04
    Rujimas Khumtong, Timo Krings, Vitor M. Pereira, Aleksandra Pikula, Joanna D. Schaafsma

    Different CT-based protocols are being used in acute ischemic stroke. We aimed to assess the added value of delayed-phase CT angiography (CTA) and CT perfusion (CTP) to a basic protocol using non-contrast computerized tomography (NCCT) with arterial-phase CTA in patient selection for mechanical thrombectomy.

    更新日期:2020-01-04
  • Silent MRA: arterial spin labeling magnetic resonant angiography with ultra-short time echo assessing cerebral arteriovenous malformation
    Neuroradiology (IF 2.504) Pub Date : 2020-01-03
    Nobuhiko Arai, Takenori Akiyama, Kazuhiro Fujiwara, Kazunari Koike, Satoshi Takahashi, Takashi Horiguchi, Masahiro Jinzaki, Kazunari Yoshida

    MR angiography using the silent MR angiography algorithm (silent MRA), which combines arterial spin labeling and an ultrashort time echo, has not been used for the evaluation of cerebral arteriovenous malformations (CAVMs). We aimed to determine the usefulness of silent MRA for the evaluation of CAVMs.

    更新日期:2020-01-04
  • Jugular venous reflux may mimic type I dural arterio-venous fistula on arterial spin labeling magnetic resonance images
    Neuroradiology (IF 2.504) Pub Date : 2020-01-03
    Sarah Toledano-Massiah, Neesmah Badat, Camille Ghorra, Ahmad Sayadi, Raphael Blanc, Sophie Gerber, Marc Zins, Xavier Leclerc, Jérôme Hodel

    Previous studies have shown that arterial spin-labeling (ASL) has high sensitivity and specificity for detecting dural arteriovenous fistulas (DAVFs). However, in case of jugular venous reflux (JVR), the labeled protons in the jugular vein may lead to a venous hypersignal in the jugular vein, sigmoid, and transverse sinus on ASL images and mimic DAVF.

    更新日期:2020-01-04
  • A practical protocol for shortening reconstruction time of volumetric data and imaging bilateral middle cerebral arteries for thrombectomy in acute ischemic stroke using an 80-row computed tomography scanner
    Neuroradiology (IF 2.504) Pub Date : 2019-11-12
    Takahisa Mori, Kazuhiro Yoshioka

    Time-consuming reconstruction of volumetric data by area-detector-computed tomography (ADCT) scanning and narrow coverage of small-row ADCT may hinder volumetric scanning in acute stroke stage. To design a practical protocol of volumetric scanning for thrombectomy using an 80-row ADCT. An imaging protocol that focuses on the middle cerebral arteries by tilting the gantry of an 80-row ADCT with 0.5-mm-thick detectors can shorten the reconstruction time by 1.0-mm thickness scanning without subtraction. The reconstruction time of small volumetric data was 69 second. This practical protocol is applicable before thrombectomy in different stroke centres with narrow-coverage ADCT scanners.

    更新日期:2020-01-04
  • Atherosclerotic ICA stenosis coinciding with ICA asymmetry associated with Circle of Willis variations can mimic near-occlusion
    Neuroradiology (IF 2.504) Pub Date : 2019-11-08
    Elias Johansson, Richard I. Aviv, Allan J. Fox

    Abstract Differentiating carotid near-occlusion (tight atherosclerotic stenosis causing distal artery size reduction) from conventional stenosis is the first step when grading carotid stenoses with NASCET method. The internal carotid artery (ICA) can be asymmetrically associated with Circle of Willis variations. When such ICA asymmetry coincides with stenosis, it may mimic near-occlusion. We studied ICA anatomical variant prevalence in 4042 consecutive CTA exams from all indications, 53 excluded due to carotid occlusion, 814 with any ≥ 50% steno-occlusive disease intra- or extracranially, 3228 without. Of the 3989 included cases, 568 (14%) had ICA asymmetry, of which 335 (59%) were from associated with Circle of Willis variations. Of 3228 patients without ≥ 50% stenosis or other steno-occlusive disease intra- and extracranially; 257 (8.0%) demonstrated ICA asymmetry associated with Circle of Willis variations, equally common among sexes and age unrelated and most frequently attributed to an ipsilateral A1 hypoplasia/aplasia, less often attributed to large contralateral posterior communicating artery. As ICA asymmetry associated with Circle of Willis variations are common, caution should be exercised diagnosing near-occlusion on asymmetry alone.

    更新日期:2020-01-04
  • Focal hyperemia in Wernicke’s encephalopathy: a preliminary arterial spin labeling MRI study
    Neuroradiology (IF 2.504) Pub Date : 2019-11-15
    Sang-Bae Ko, Tae Jung Kim, Chul-Ho Sohn

    Abstract Although a perturbed cerebral blood flow (CBF) has been reported in patients with Wernicke’s encephalopathy (WE), its clinical meaning is still elusive. A retrospective analysis of 10 patients (male, 6; mean age, 57.7 years) with WE between October 2012 and May 2018 was performed. Brain imaging was performed using fluid-attenuated inversion recovery (FLAIR), diffusion-weighted imaging (DWI), arterial spin labeling (ASL) perfusion-weighted imaging (PWI), and contrasted enhanced T1-weighted imaging. All patients had symmetric high signal intensity lesions in the vulnerable areas on FLAIR or DWI with focal hyperintensity on ASL-PWI (100% sensitivity). CBFlesion was variable (from 70 mL/100 g/min to 190.0 mL/100 g/min). CBFlesion/CBFwhite matter was elevated, ranging from 2.5 to 5.5. Focal hyperintensity on ASL in the vulnerable areas can be a diagnostic clue for WE.

    更新日期:2020-01-04
  • Venous pathologies in paediatric neuroradiology: from foetal to adolescent life
    Neuroradiology (IF 2.504) Pub Date : 2019-11-09
    Kshitij Mankad, Asthik Biswas, Maria Camilla Rossi Espagnet, Luke Dixon, Nihaal Reddy, Ai Peng Tan, Ozgur Oztekin, Felice D’Arco, Karuna Shekdar, Prakash Muthusami, Fergus Robertson, Stacy Goergen, Winston Chong

    The interpretation of cerebral venous pathologies in paediatric practice is challenging as there are several normal anatomical variants, and the pathologies are diverse, involving the venous system through direct and indirect mechanisms. This paper aims to provide a comprehensive review of these entities, as their awareness can avoid potential diagnostic pitfalls. We also propose a practical classification system of paediatric cerebral venous pathologies, which will enable more accurate reporting of the neuroimaging findings, as relevant to the underlying pathogenesis of these conditions. The proposed classification system comprises of the following main groups: arterio-venous shunting–related disorders, primary venous malformations and veno-occlusive disorders. A multimodal imaging approach has been included in the relevant subsections, with a brief overview of the modality-specific pitfalls that can also limit interpretation of the neuroimaging. The article also summarises the current literature and international practices in terms of management options and outcomes in specific disease entities.

    更新日期:2020-01-04
  • Metal artifact reduction algorithm for image quality improvement of cone-beam CT images of medium or large cerebral aneurysms treated with stent-assisted coil embolization
    Neuroradiology (IF 2.504) Pub Date : 2019-11-07
    Satoshi Murai, Masafumi Hiramatsu, Yuji Takasugi, Yu Takahashi, Naoya Kidani, Shingo Nishihiro, Yukei Shinji, Jun Haruma, Tomohito Hishikawa, Kenji Sugiu, Isao Date

    The aim of the present study was to assess image quality improvement using a metal artifact reduction (MAR) algorithm in cases of medium or large cerebral aneurysms treated with stent-assisted coil embolization (SAC), and to analyze factors associated with the usefulness of the MAR algorithm.

    更新日期:2020-01-04
  • Role of diffusion weighted imaging for differentiating cerebral pilocytic astrocytoma and ganglioglioma BRAF V600E-mutant from wild type
    Neuroradiology (IF 2.504) Pub Date : 2019-10-30
    Antonia Ramaglia, Domenico Tortora, Kshitij Mankad, Maarten Lequin, Mariasavina Severino, Felice D’Arco, Ulrike Löbel, Massimo Benenati, Wendy W. J. de Leng, Patrizia De Marco, Claudia Milanaccio, Andrea Rossi, Giovanni Morana

    Abstract Purpose BRAF V600E mutation is a distinctive genomic alteration of pediatric low-grade gliomas with prognostic and therapeutic implications. The aim of this retrospective multicenter study was to analyze imaging features of BRAF V600E-mutant and wild-type cerebral pilocytic astrocytomas (PAs) and gangliogliomas (GGs), focusing on the role of diffusion weighted imaging (DWI). Methods We retrospectively evaluated 56 pediatric patients with histologically proven, treatment-naïve PAs and GGs who underwent conventional MRI, DWI, and molecular analysis for BRAF V600E mutation. Twenty-three subjects presented BRAF V600E-mutant (12 PAs and 11 GGs) and 33 BRAF V600E wild-type (26 PAs and 7 GGs) tumors. Imaging studies were reviewed for dominant site, margin definition, hemorrhage, calcification, cystic components, contrast enhancement, and relative mean and minimum ADC values (rADCmean and rADCmin). Statistics included Fisher’s exact test, Student t test, general linear model, and receiver operating characteristic (ROC) analysis. Results PA and GG BRAF V600E-mutant had significantly lower rADCmean (p < 0.001) and rADCmin (p < 0.001) values than wild type, regardless of tumor histology and location. ROC analysis demonstrated similar performances between these parameters in predicting BRAF V600E status (rADCmean: AUC 0.831, p < 0.001; rADCmin: AUC 0.885, p < 0.001). No significant differences regarding additional imaging features emerged between BRAF V600E-mutant and wild-type lesions, with the exception of the number of tumors with cystic components, significantly higher in BRAF V600E-mutant PAs (p = 0.011) Conclusion Assessment of the DWI characteristics of GGs and PAs may assist in predicting BRAF V600E status, suggesting a radiogenomic correlation and prompt molecular characterization of these tumors.

    更新日期:2020-01-04
  • Altered Granger causality connectivity within motor-related regions of patients with Parkinson’s disease: a resting-state fMRI study
    Neuroradiology (IF 2.504) Pub Date : 2019-11-26
    Li Hao, Zhao Sheng, Wang Ruijun, He Zhi Kun, Zhang Peng, Hong Yu

    Abstract Purpose Although numerous clinical neuroimaging studies have demonstrated that there are functional abnormalities of motor-related regions in patients with Parkinson’s disease (PD) by resting-state functional magnetic resonance imaging (fMRI), little studies have explored the causal interactions within these motor-related regions. The present study aimed to examine Granger causality connectivity patterns within motor-related regions in PD patients. Methods Resting-state fMRI was conducted to investigate the causal connectivity differences within motor-related regions between 17 PD patients and 17 matched healthy controls. Subsequently, the relationship between the Unified Parkinson’s Disease Rating Scale scores and causal connectivity values within motor-related regions was examined in PD patients. Results An increased causal connectivity from the left premotor cortex (PMC) to right primary motor cortex (M1) was found in PD patients compared with that of healthy controls. Also, increased causal flow from the PMC to M1 was negatively correlated with motor scores. Conclusion PD patients have abnormal causal connectivity in specific motor-related regions, which may reflect a compensatory role of motor deficits in PD patients.

    更新日期:2020-01-04
  • A rupture risk analysis of cerebral cavernous malformation associated with developmental venous anomaly using susceptibility-weighted imaging
    Neuroradiology (IF 2.504) Pub Date : 2019-09-03
    Shuo Zhang, Li Ma, Chunxue Wu, Jun Wu, Yong Cao, Shuo Wang, Jizong Zhao

    To search for the risk factors closely related to cerebral cavernous malformation associated with developmental venous anomaly (CCM-DVA) lesions rupture, laying foundations for the development of reasonable individual treatment plans for patients.

    更新日期:2020-01-04
  • Clinico-radiological correlation of magnetic resonance imaging findings in patients with idiopathic intracranial hypertension
    Neuroradiology (IF 2.504) Pub Date : 2019-09-10
    H. Wong, K. Sanghera, A. Neufeld, C. Maxner, Jai Jai Shiva Shankar

    Although several studies have reported imaging findings associated with idiopathic intracranial hypertension (IIH), less is known about the correlation between imaging findings and IIH-related symptoms or signs. Our study aimed to determine if clinical features of IIH are correlated with magnetic resonance imaging (MRI) features.

    更新日期:2020-01-04
  • Standards for European training requirements in interventional neuroradiology
    Neuroradiology (IF 2.504) Pub Date : 2019-11-01
    Marek Sasiadek, Naci Kocer, Istvan Szikora, Pedro Vilela, Mario Muto, Olav Jansen, Francesco Causin, Christophe Cognard, Phil White, Patrick A. Brouwer, Francesca B. Pizzini, Gerhard Schroth, Paolo Ricci

    Abstract This document sets out standards for training in Interventional Neuroradiology (INR) in Europe. These standards have been developed by a working group of the European Society of Neuroradiology (ESNR) and the European Society of Minimally Invasive Neurological Therapy (ESMINT) on the initiative and under the umbrella of the Division of Neuroradiology/Section of Radiology of the European Union of Medical Specialists (UEMS).

    更新日期:2020-01-04
  • Differentiation of pilocytic and pilomyxoid astrocytomas using dynamic susceptibility contrast perfusion and diffusion weighted imaging
    Neuroradiology (IF 2.504) Pub Date : 2019-11-01
    Chang Y. Ho, Nucharin Supakul, Parth U. Patel, Vetana Seit, Michael Groswald, Jeremy Cardinal, Chen Lin, Stephen F. Kralik

    Pilocytic (PA) and pilomyxoid astrocytomas (PMA) are related low-grade tumors which occur predominantly in children. PMAs have a predilection for a supratentorial location in younger children with worse outcomes. However, the two have similar imaging characteristics. Quantitative MR sequences such as dynamic susceptibility contrast (DSC) perfusion and diffusion (DWI) were assessed for significant differences between the two tumor types and locations.

    更新日期:2020-01-04
  • Evaluation of intervertebral disc using T2 mapping sequences in patients undergoing O 2 –O 3 chemiodiscolysis: an instrumental study with clinical correlation
    Neuroradiology (IF 2.504) Pub Date : 2019-11-23
    Federico Bruno, Pierpaolo Palumbo, Emanuele Tommasino, Giampaolo Bianchi, Marco Varrassi, Francesco Arrigoni, Antonio Barile, Ernesto Di Cesare, Carlo Masciocchi, Alessandra Splendiani

    Abstract Purpose To assess the MRI modifications of the intervertebral disc (IVD) treated by chemiodiscolysis using T2 mapping sequences. Methods Thirty sciatica patients (17 males, 13 females, mean age 47.52 years) were enrolled for percutaneous CT-guided O2–O3 chemiodiscolysis treatment. As a control group, we enrolled 30 patients who were treated by CT-guided periradicular injections. All patients were submitted to clinical (using VAS and Oswestry Disability index (ODI)) and imaging studies to evaluate the intervertebral disc area (IDA) and T2 mapping values of the IVD before and at 1-month follow-up. Results In the study group, pre-treatment IDA mean values were 20.47 ± 1.62 cm2, with significant reduction at the follow-up (P < 0.05). Mean pre-treatment T2 relaxation time values were 38.80 ± 4.51 ms, 44.05 ± 0.91 ms, and 45.45 ± 14.11 ms for anterior annulus fibrosus, nucleus pulposus (NP), and posterior annulus fibrosus, respectively, with significant increase at the level of the NP (P < 0.05) at the follow-up. Mean pre-treatment ODI and VAS scores were 21.5 ± 10.6 and 8.5 ± 0.57, with significant improvement at the post-treatment follow-up (P < 0.05). In the control group, despite clinical improvement, we did not find significant IVA reduction nor significant T2 values change after treatment. Correlation analysis of T2 mapping relaxation time values showed significant correlation of NP T2 mapping value with both the reduction of IDA (0.81, P < 0.001) and the improvement of VAS and ODI scores (0.86, P < 0.001) at 1 month. In the control group, we did not find any statistically significant correlation. Conclusions T2 mapping may be a useful indicator to predict disc shrinkage and the clinical response to CT-guided O2–O3 injection.

    更新日期:2020-01-04
  • Abnormal brain white matter in patients with hemifacial spasm: a diffusion tensor imaging study.
    Neuroradiology (IF 2.504) Pub Date : null
    Chenguang Guo,Hui Xu,Xuan Niu,Samuel Krimmel,Jixin Liu,Lin Gao,Ming Zhang,Yuan Wang

    PURPOSE Refractory hemifacial contraction and comorbid emotional disorders are major annoyance suffered by patients with hemifacial spasm (HFS). It is currently unknown how whiter matter (WM) abnormalities in the brain contribute to HFS. METHODS To investigate WM alterations in HFS, 26 patients and 29 matched healthy controls were ultimately recruited in this experiment. The whole brain diffusion tensor imaging (DTI) was acquired at 3.0 Tesla scanner. Tract-based spatial statistics (TBSS) analysis was applied to investigate the differences of DTI metrics (fractional anisotropy (FA), mean diffusivity (MD), radial diffusivity (RD) axial diffusivity (AD)) between HFS patients and controls throughout brain WM. The relationship between the severity of facial spasm and affective disturbance in HFS patients, and WM abnormalities was examined using spearman correlation analyses. RESULTS TBSS method showed structural alterations in the genu and body of corpus callosum; bilateral inferior longitudinal fasciculus (ILF) and inferior frontal-occipital fasciculus (IFOF); left superior longitudinal fasciculus, anterior, posterior, and superior portion of corona radiata; left posterior limb of the internal capsule; and left posterior thalamic radiation in HFS patients compared with healthy subjects. In addition, the overlapped region of decreased FA together with increased RD and MD was merely localized in the right ILF and IFOF in the HFS group, and abnormality of RD value in this region was positively correlated with the patients' spasm score. CONCLUSIONS The present study indicate extensive disruptions of WM integrity, especially the RD changes in right ILF and IFOF, which may provide alternative imaging clues for evaluating the characteristics of HFS.

    更新日期:2019-11-01
  • XV CONGRESSO SPNR.
    Neuroradiology (IF 2.504) Pub Date : null

    更新日期:2019-11-01
  • Voxel-based analysis and multivariate pattern analysis of diffusion tensor imaging study in anti-NMDA receptor encephalitis.
    Neuroradiology (IF 2.504) Pub Date : null
    Yanli Liang,Luhui Cai,Xia Zhou,Huanjian Huang,Jinou Zheng

    PURPOSE This study aimed to investigate brain white matter (WM) changes and their relationship to cognition in patients with anti-N-methyl-D-aspartate (anti-NMDA) receptor encephalitis. Multivariate pattern analysis (MVPA) was used to explore brain regions that play an important role in classification. METHODS Fifteen patients and fifteen controls underwent Montreal Cognitive Assessment (MoCA) and diffusion tensor imaging. Based on fractional anisotropy (FA) and mean diffusivity (MD) for MVPA classification, the weights of each brain region were calculated. RESULTS Compared with the controls, the patients showed an FA reduction in right middle temporal gyrus, left middle cerebellar peduncle, right praecuneus, and an MD increase in left medial temporal gyrus and left frontal lobe. The MoCA score for patients was lower than controls, especially in executive function, fluency, delayed recall and visual perception items. The FA value of right praecuneus was positively correlated with total MoCA score and fluency score. The MD of left frontal lobe was negatively correlated with total MoCA score, and MD of the left medial temporal gyrus was positively correlated with delayed recall. The accuracy, sensitivity and specificity of classification based on FA were 70%, 60% and 80%, respectively. Based on MD, they were each 80%. The brain regions with large weights from FA and MD overlap in temporal lobe, cerebellum and hippocampus. CONCLUSIONS These results suggest that WM changes are associated with cognitive deficits. MVPA based on FA and MD has good classification ability. Our study may provide new insights into the pathophysiological mechanisms of residual cognitive deficits.

    更新日期:2019-11-01
  • Altered Granger causality connectivity within motor-related regions of patients with Parkinson's disease: a resting-state fMRI study.
    Neuroradiology (IF 2.504) Pub Date : null
    Li Hao,Zhao Sheng,Wang Ruijun,He Zhi Kun,Zhang Peng,Hong Yu

    PURPOSE Although numerous clinical neuroimaging studies have demonstrated that there are functional abnormalities of motor-related regions in patients with Parkinson's disease (PD) by resting-state functional magnetic resonance imaging (fMRI), little studies have explored the causal interactions within these motor-related regions. The present study aimed to examine Granger causality connectivity patterns within motor-related regions in PD patients. METHODS Resting-state fMRI was conducted to investigate the causal connectivity differences within motor-related regions between 17 PD patients and 17 matched healthy controls. Subsequently, the relationship between the Unified Parkinson's Disease Rating Scale scores and causal connectivity values within motor-related regions was examined in PD patients. RESULTS An increased causal connectivity from the left premotor cortex (PMC) to right primary motor cortex (M1) was found in PD patients compared with that of healthy controls. Also, increased causal flow from the PMC to M1 was negatively correlated with motor scores. CONCLUSION PD patients have abnormal causal connectivity in specific motor-related regions, which may reflect a compensatory role of motor deficits in PD patients.

    更新日期:2019-11-01
  • Diagnostic accuracy of flat-panel computed tomography in assessing cerebral perfusion in comparison with perfusion computed tomography and perfusion magnetic resonance: a systematic review.
    Neuroradiology (IF 2.504) Pub Date : 2019-09-17
    Ernst L Stille,Ilaria Viozzi,Mark Ter Laan,Frederick J A Meijer,Jurgen J Futterer,Maroeska M Rovers

    PURPOSE Flat-panel computed tomography (FP-CT) is increasingly available in angiographic rooms and hybrid OR's. Considering its easy access, cerebral imaging using FP-CT is an appealing modality for intra-procedural applications. The purpose of this systematic review is to assess the diagnostic accuracy of FP-CT compared with perfusion computed tomography (CTP) and perfusion magnetic resonance (MRP) in cerebral perfusion imaging. METHODS We performed a systematic literature search in the Cochrane Library, MEDLINE, Embase, and Web of Science up to June 2019 for studies directly comparing FP-CT with either CTP or MRP in vivo. Methodological quality was assessed using the QUADAS-2 tool. Data on diagnostic accuracy was extracted and pooled if possible. RESULTS We found 11 studies comparing FP-CT with CTP and 5 studies comparing FP-CT with MRP. Most articles were pilot or feasibility studies, focusing on scanning and contrast protocols. All patients studied showed signs of cerebrovascular disease. Half of the studies were animal trials. Quality assessment showed unclear to high risks of bias and low concerns regarding applicability. Five studies reported on diagnostic accuracy; FP-CT shows good sensitivity (range 0.84-1.00) and moderate specificity (range 0.63-0.88) in detecting cerebral blood volume (CBV) lesions. CONCLUSIONS Even though FP-CT provides similar CBV values and reconstructed blood volume maps as CTP in cerebrovascular disease, additional studies are required in order to reliably compare its diagnostic accuracy with cerebral perfusion imaging.

    更新日期:2019-11-01
  • Convolutional neural network-based segmentation can help in assessing the substantia nigra in neuromelanin MRI.
    Neuroradiology (IF 2.504) Pub Date : 2019-08-12
    Alice Le Berre,Koji Kamagata,Yujiro Otsuka,Christina Andica,Taku Hatano,Laetitia Saccenti,Takashi Ogawa,Haruka Takeshige-Amano,Akihiko Wada,Michimasa Suzuki,Akifumi Hagiwara,Ryusuke Irie,Masaaki Hori,Genko Oyama,Yashushi Shimo,Atsushi Umemura,Nobutaka Hattori,Shigeki Aoki

    PURPOSE This study aimed to evaluate the accuracy and diagnostic test performance of the U-net-based segmentation method in neuromelanin magnetic resonance imaging (NM-MRI) compared to the established manual segmentation method for Parkinson's disease (PD) diagnosis. METHODS NM-MRI datasets from two different 3T-scanners were used: a "principal dataset" with 122 participants and an "external validation dataset" with 24 participants, including 62 and 12 PD patients, respectively. Two radiologists performed SNpc manual segmentation. Inter-reader precision was determined using Dice coefficients. The U-net was trained with manual segmentation as ground truth and Dice coefficients used to measure accuracy. Training and validation steps were performed on the principal dataset using a 4-fold cross-validation method. We tested the U-net on the external validation dataset. SNpc hyperintense areas were estimated from U-net and manual segmentation masks, replicating a previously validated thresholding method, and their diagnostic test performances for PD determined. RESULTS For SNpc segmentation, U-net accuracy was comparable to inter-reader precision in the principal dataset (Dice coefficient: U-net, 0.83 ± 0.04; inter-reader, 0.83 ± 0.04), but lower in external validation dataset (Dice coefficient: U-net, 079 ± 0.04; inter-reader, 0.85 ± 0.03). Diagnostic test performances for PD were comparable between U-net and manual segmentation methods in both principal (area under the receiver operating characteristic curve: U-net, 0.950; manual, 0.948) and external (U-net, 0.944; manual, 0.931) datasets. CONCLUSION U-net segmentation provided relatively high accuracy in the evaluation of the SNpc in NM-MRI and yielded diagnostic performance comparable to that of the established manual method.

    更新日期:2019-11-01
  • Standardized image evaluation in patients with idiopathic normal pressure hydrocephalus: consistency and reproducibility.
    Neuroradiology (IF 2.504) Pub Date : 2019-08-11
    Karin Kockum,Johan Virhammar,Katrine Riklund,Lars Söderström,Elna-Marie Larsson,Katarina Laurell

    PURPOSE Assess the agreement for two investigators between computed tomography (CT) and magnetic resonance imaging (MRI) for seven imaging features included in the iNPH Radscale, a radiological screening tool. METHODS The study included 35 patients with idiopathic normal pressure hydrocephalus (iNPH) who were treated surgically from 2011 to 2015 at Uppsala University Hospital with preoperative CT and MRI performed with maximum 3 months between scans. Seven features were assessed: Evans' index, temporal horn size, callosal angle, periventricular white matter changes, narrow high convexity sulci, focally enlarged sulci, and enlarged Sylvian fissures. All scans were assessed by two investigators who were blinded to each other's results and to clinical data. RESULTS The agreement between CT and MRI was almost perfect for Evans' index, temporal horns, narrow sulci, and Sylvian fissures (kappa and intraclass correlation, 0.84-0.91, p ≤ 0.001). There was substantial to almost perfect agreement for callosal angle and focally enlarged sulci. The concordance between modalities was fair for changes in periventricular white matter. CONCLUSION CT and MRI are equally good for assessing radiological signs associated with iNPH except for periventricular white matter changes, as MRI has superior soft tissue contrast. The other imaging features can be evaluated consistently, and assessments are reproducible independent of modality. Therefore, the iNPH Radscale is applicable to both CT and MRI and may become an important tool for standardized evaluation in the workup in patients with suspected iNPH.

    更新日期:2019-11-01
  • Reliability of dynamic contrast-enhanced magnetic resonance imaging data in primary brain tumours: a comparison of Tofts and shutter speed models.
    Neuroradiology (IF 2.504) Pub Date : 2019-08-09
    Marianna Inglese,Katherine L Ordidge,Lesley Honeyfield,Tara D Barwick,Eric O Aboagye,Adam D Waldman,Matthew Grech-Sollars

    PURPOSE The purpose of this study is to investigate the robustness of pharmacokinetic modelling of DCE-MRI brain tumour data and to ascertain reliable perfusion parameters through a model selection process and a stability test. METHODS DCE-MRI data of 14 patients with primary brain tumours were analysed using the Tofts model (TM), the extended Tofts model (ETM), the shutter speed model (SSM) and the extended shutter speed model (ESSM). A no-effect model (NEM) was implemented to assess overfitting of data by the other models. For each lesion, the Akaike Information Criteria (AIC) was used to build a 3D model selection map. The variability of each pharmacokinetic parameter extracted from this map was assessed with a noise propagation procedure, resulting in voxel-wise distributions of the coefficient of variation (CV). RESULTS The model selection map over all patients showed NEM had the best fit in 35.5% of voxels, followed by ETM (32%), TM (28.2%), SSM (4.3%) and ESSM (< 0.1%). In analysing the reliability of Ktrans, when considering regions with a CV < 20%, ≈ 25% of voxels were found to be stable across all patients. The remaining 75% of voxels were considered unreliable. CONCLUSIONS The majority of studies quantifying DCE-MRI data in brain tumours only consider a single model and whole tumour statistics for the output parameters. Appropriate model selection, considering tissue biology and its effects on blood brain barrier permeability and exchange conditions, together with an analysis on the reliability and stability of the calculated parameters, is critical in processing robust brain tumour DCE-MRI data.

    更新日期:2019-11-01
  • Evaluation of intervertebral disc using T2 mapping sequences in patients undergoing O2-O3 chemiodiscolysis: an instrumental study with clinical correlation.
    Neuroradiology (IF 2.504) Pub Date : 2019-11-25
    Federico Bruno,Pierpaolo Palumbo,Emanuele Tommasino,Giampaolo Bianchi,Marco Varrassi,Francesco Arrigoni,Antonio Barile,Ernesto Di Cesare,Carlo Masciocchi,Alessandra Splendiani

    PURPOSE To assess the MRI modifications of the intervertebral disc (IVD) treated by chemiodiscolysis using T2 mapping sequences. METHODS Thirty sciatica patients (17 males, 13 females, mean age 47.52 years) were enrolled for percutaneous CT-guided O2-O3 chemiodiscolysis treatment. As a control group, we enrolled 30 patients who were treated by CT-guided periradicular injections. All patients were submitted to clinical (using VAS and Oswestry Disability index (ODI)) and imaging studies to evaluate the intervertebral disc area (IDA) and T2 mapping values of the IVD before and at 1-month follow-up. RESULTS In the study group, pre-treatment IDA mean values were 20.47 ± 1.62 cm2, with significant reduction at the follow-up (P < 0.05). Mean pre-treatment T2 relaxation time values were 38.80 ± 4.51 ms, 44.05 ± 0.91 ms, and 45.45 ± 14.11 ms for anterior annulus fibrosus, nucleus pulposus (NP), and posterior annulus fibrosus, respectively, with significant increase at the level of the NP (P < 0.05) at the follow-up. Mean pre-treatment ODI and VAS scores were 21.5 ± 10.6 and 8.5 ± 0.57, with significant improvement at the post-treatment follow-up (P < 0.05). In the control group, despite clinical improvement, we did not find significant IVA reduction nor significant T2 values change after treatment. Correlation analysis of T2 mapping relaxation time values showed significant correlation of NP T2 mapping value with both the reduction of IDA (0.81, P < 0.001) and the improvement of VAS and ODI scores (0.86, P < 0.001) at 1 month. In the control group, we did not find any statistically significant correlation. CONCLUSIONS T2 mapping may be a useful indicator to predict disc shrinkage and the clinical response to CT-guided O2-O3 injection.

    更新日期:2019-11-01
  • Flow diverter treatment of posterior circulation aneurysms. A meta-analysis.
    Neuroradiology (IF 2.504) Pub Date : 2016-01-24
    Cheng-Bin Wang,Wen-Wen Shi,Guang-Xu Zhang,Hu-Chen Lu,Jun Ma

    INTRODUCTION Treatment of complex anterior circulation aneurysms with flow diverters (FDs) has become common practice in neurovascular centers. However, this treatment method for posterior circulation aneurysms (PCAs) still remains controversial. METHODS Through searches for reports on the treatment of PCAs with FDs, we conducted a systematic review of the literature on its clinical efficacy and safety using random-effect binomial meta-analysis. RESULTS We included 14 studies, which reported on a total of 225 PCAs in 220 patients. Procedure-related good outcome rate was 79% (95% confidence interval (CI), 72-84), with significantly lower odds among patients with ruptured aneurysms and basilar artery aneurysms. Procedure-related mortality rate was 15% (95% CI 10-21), with significantly higher rates among patients with giant aneurysms and basilar artery aneurysms. The rate of complete aneurysm occlusion at 6-month digital subtraction angiography (DSA) was 84%. Ischemic stroke rate was 11%. Perforator infarction rate was 7%. Postoperative subarachnoid hemorrhage (SAH) rate was 3%. Intraparenchymal hemorrhage (IPH) rate was 4%. CONCLUSIONS Flow diverter treatment of PCAs is an effective method, which provides a high rate of complete occlusion at 6-month DSA. However, compared with anterior circulation aneurysms, patients with PCAs are at significantly higher risk of mortality, ischemic stroke and perforator infarction. Our findings indicate that, in most clinical centers, flow diverter treatment of PCAs should be conducted in carefully selected patients with poor natural history and no optimal treatment strategy. For ruptured and giant basilar artery aneurysms, there is still no good treatment option.

    更新日期:2019-11-01
  • Correction to: Stent placement in patients with acute subarachnoid haemorrhage: when is it justified?
    Neuroradiology (IF 2.504) Pub Date : 2018-05-17
    Andrew G Murchison,Victoria Young,Tanja Djurdjevic,Martino Cellerini,Rufus Corkill,Wilhelm Küker

    In the original version of this article one author name was published incorrectly: Tanja Ddjurdjevic has been corrected to Tanja Djurdjevic.

    更新日期:2019-11-01
  • Erratum to: Training guidelines for endovascular stroke intervention: an international multi-society consensus document.
    Neuroradiology (IF 2.504) Pub Date : 2017-06-22
    S D Lavine,K Cockroft,B Hoh,N Bambakidis,A A Khalessi,H Woo,H Riina,A Siddiqui,J A Hirsch,W Chong,H Rice,J Wenderoth,P Mitchell,A Coulthard,T J Signh,C Phatouros,M Khangure,P Klurfan,K Ter Brugge,D Iancu,T Gunnarsson,O Jansen,M Muto,I Szikora,L Pierot,P Brouwer,J Gralla,S Renowden,T Andersson,J Fiehler,F Turjman,P White,A C Januel,L Spelle,Z Kulcsar,R Chapot,A Biondi,S Dima,C Taschner,M Szajner,A Krajina,N Sakai,Y Matsumaru,S Yoshimura,M Ezura,T Fujinaka,K Iihara,A Ishii,T Higashi,M Hirohata,A Hyodo,Y Ito,M Kawanishi,H Kiyosue,E Kobayashi,S Kobayashi,N Kuwayama,Y Matsumoto,S Miyachi,Y Murayama,I Nagata,I Nakahara,S Nemoto,Y Niimi,H Oishi,J Satomi,T Satow,K Sugiu,M Tanaka,T Terada,H Yamagami,O Diaz,P Lylyk,M V Jayaraman,A Patsalides,C D Gandhi,S K Lee,T Abruzzo,B Albani,S A Ansari,A S Arthur,B W Baxter,K R Bulsara,M Chen,J E Delgado Almandoz,J F Fraser,D V Heck,S W Hetts,M S Hussain,R P Klucznik,T M Leslie-Mawzi,W J Mack,R A McTaggart,P M Meyers,J Mocco,C J Prestigiacomo,G L Pride,P A Rasmussen,R M Starke,P J Sunenshine,R W Tarr,D F Frei,M Ribo,R G Nogueira,O O Zaidat,T Jovin,I Linfante,D Yavagal,D Liebeskind,R Novakovic,S Pongpech,G Rodesch,M Soderman,A Taylor,T Krings,D Orbach,L Picard,D C Suh,H Q Zhang

    更新日期:2019-11-01
  • Correction to: Diagnostic performance of an unenhanced MRI exam for tumor follow-up of the optic pathway gliomas in children.
    Neuroradiology (IF 2.504) Pub Date : 2019-04-24
    Pierre Marsault,Stéphane Ducassou,Fanny Menut,Pierre Bessou,Marion Havez-Enjolras,Jean-François Chateil

    In the article "Diagnostic performance of an unenhanced MRI exam for tumor follow-up of the optic pathway gliomas in children", Table 2 data were not presented correctly, with results placed beneath an incorrect heading. Confidence interval also added. The original article has been corrected.

    更新日期:2019-11-01
  • Focal hyperemia in Wernicke's encephalopathy: a preliminary arterial spin labeling MRI study.
    Neuroradiology (IF 2.504) Pub Date : null
    Sang-Bae Ko,Tae Jung Kim,Chul-Ho Sohn

    Although a perturbed cerebral blood flow (CBF) has been reported in patients with Wernicke's encephalopathy (WE), its clinical meaning is still elusive. A retrospective analysis of 10 patients (male, 6; mean age, 57.7 years) with WE between October 2012 and May 2018 was performed. Brain imaging was performed using fluid-attenuated inversion recovery (FLAIR), diffusion-weighted imaging (DWI), arterial spin labeling (ASL) perfusion-weighted imaging (PWI), and contrasted enhanced T1-weighted imaging. All patients had symmetric high signal intensity lesions in the vulnerable areas on FLAIR or DWI with focal hyperintensity on ASL-PWI (100% sensitivity). CBFlesion was variable (from 70 mL/100 g/min to 190.0 mL/100 g/min). CBFlesion/CBFwhite matter was elevated, ranging from 2.5 to 5.5. Focal hyperintensity on ASL in the vulnerable areas can be a diagnostic clue for WE.

    更新日期:2019-11-01
  • Standards for European training requirements in interventional neuroradiology : Guidelines by the Division of Neuroradiology/Section of Radiology European Union of Medical Specialists (UEMS), in cooperation with the Division of Interventional Radiology/UEMS, the European Society of Neuroradiology (ESNR), and the European Society of Minimally Invasive Neurological Therapy (ESMINT).
    Neuroradiology (IF 2.504) Pub Date : 2019-11-05
    Marek Sasiadek,Naci Kocer,Istvan Szikora,Pedro Vilela,Mario Muto,Olav Jansen,Francesco Causin,Christophe Cognard,Phil White,Patrick A Brouwer,Francesca B Pizzini,Gerhard Schroth,Paolo Ricci

    This document sets out standards for training in Interventional Neuroradiology (INR) in Europe. These standards have been developed by a working group of the European Society of Neuroradiology (ESNR) and the European Society of Minimally Invasive Neurological Therapy (ESMINT) on the initiative and under the umbrella of the Division of Neuroradiology/Section of Radiology of the European Union of Medical Specialists (UEMS).

    更新日期:2019-11-01
  • Discrimination of HPV status using CT texture analysis: tumour heterogeneity in oropharyngeal squamous cell carcinomas.
    Neuroradiology (IF 2.504) Pub Date : 2019-10-24
    Ji Young Lee,Miran Han,Kap Seon Kim,Su-Jin Shin,Jin Wook Choi,Eun Ju Ha

    PURPOSE To evaluate the diagnostic performance of texture analysis for discriminating human papillomavirus (HPV) status in patients with oropharyngeal squamous cell carcinoma (OPSCC) in the primary tumours and metastatic lymph nodes. METHODS Ninety-five patients with primary tumour and 91 with metastatic lymph nodes with confirmed HPV status, who underwent pretreatment contrast-enhanced CT (CECT), were included as the discovery population. CT texture analysis was performed using commercially available software. Differences between HPV-positive and HPV-negative groups were analysed using the χ2 test (or Mann-Whitney U test) and independent t test (or Fisher's exact test). ROC curve analysis was performed to discriminate HPV status according to heterogeneity parameters. Diagnostic accuracy was evaluated in the separate validation population (n = 36) from an outside hospital. RESULTS HPV positivity was 52.6% for primary tumours and 56.0% for metastatic lymph nodes. The entropy and standard deviation (SD) values in the HPV-positive group were significantly lower. Entropy using the medium filter was the best discriminator between HPV-positive and HPV-negative primary OPSCCs (AUC, 0.85) and SD without the filter for metastatic lymph nodes (AUC, 0.82). Diagnostic accuracy of entropy for the primary tumour was 80.0% in the discovery group and 75.0% in the validation group. In cases of metastatic lymph node, the accuracy of SD was 79.1% and 78.8%, respectively. CONCLUSION Significant differences were found in heterogeneity parameters from texture analysis of pretreatment CECT, according to HPV status. Texture analysis could be used as an adjunctive tool for diagnosis of HPV status in clinical practice.

    更新日期:2019-11-01
  • Impact of hypertension on cerebral microvascular structure in CPAP-treated obstructive sleep apnoea patients: a diffusion magnetic resonance imaging study.
    Neuroradiology (IF 2.504) Pub Date : 2019-09-19
    Sira Thiel,Thomas Gaisl,Franziska Lettau,Andreas Boss,Sebastian Winklhofer,Malcolm Kohler,Cristina Rossi

    PURPOSE Obstructive sleep apnoea (OSA) is a highly prevalent sleep-related breathing disorder associated with hypertension, impaired peripheral vascular function and an increased risk of stroke. Evidence suggests that abnormalities of the cerebral microcirculation, such as capillary rarefication, may be present in these patients. We evaluated whether the presence of hypertension may affect the cerebral capillary architecture and function assessed by Intravoxel Incoherent Motion (IVIM) magnetic resonance imaging (MRI) in patients with continuous positive airway pressure (CPAP)-treated OSA. METHODS Forty-one patients (88% male, mean age 57 ± 10 years) with moderate-to-severe OSA were selected and divided into two groups (normotensive vs. hypertensive). All hypertensive OSA patients were adherent with their antihypertensive medication. Cerebral microvascular structure was assessed in grey (GM) and white matter (WM) using an echo-planar diffusion imaging sequence with 14 different b values. A step-wise IVIM analysis algorithm was applied to compute true diffusion (D), perfusion fraction (f) and pseudo-diffusion (D*) values. Group comparisons were performed with the Wilcoxon-Mann-Whitney-Test. Regression analysis was adjusted for age. RESULTS Diffusion- and perfusion-related indexes in middle-aged OSA normotensive patients were quantified in both tissue types (D [10-3 mm2/s]: GM = 0.83 ± 0.03; WM = 0.72 ± 0.03; f (%) GM = 0.09 ± 0.01; WM = 0.06 ± 0.01; D* [10-3 mm2/s]: GM = 7.72 ± 0.89; WM = 7.38 ± 0.98). In the examined tissue types, hypertension did not result in changes on the estimated MRI IVIM index values. CONCLUSION Based on IVIM analysis, cerebral microvascular structure and function showed no difference between hypertensive and normotensive patients with moderate-to-severe OSA treated with CPAP. Treatment adherence with antihypertensive drug regime and, in turn, controlled hypertension seems not to affect microvascular structure and perfusion of the brain. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02493673.

    更新日期:2019-11-01
  • Two novel parameters to evaluate the influence of the age and gender on the anatomic relationship of the atlas and axis in children no more than 8 years old: imaging study.
    Neuroradiology (IF 2.504) Pub Date : 2019-09-13
    Long Wu,Yu Jin,Xiang-Yang Wang,Bi-Dong Fang,Ai-Min Wu,Sheng Wang,Cheng-Long Xie,Zhong-Ke Lin

    PURPOSE Because of the complex cervical vertebral embryology and some normal variations, the atlantoadental interval (ADI) was not suitable for the evaluation of the anatomic relationship between the atlas and axial in children less than 2 years old. And the influence of the age and gender on the anatomic relationship between atlas and axial in children was still unclear. Two novel parameters, atlas-axis anteroposterior distance (AAAD) and atlas-axis lateral distance (AALD), were invented to evaluate the anatomic relationship between the atlas and axis in the children no more than 8 years old with different age and gender. METHODS Cross-sectional computed tomography (CT) scans of the atlantoaxial joint for 140 randomly selected pediatric patients no more than 8 years old were analyzed. On the ideal CT reconstruction images, AAAD, AALD, atlantoaxial lateral bending angle (AALB), and atlantoaxial rotation angle (AARA) were measured. RESULTS There was no statistically significant difference between the mean AAAD in different age and gender groups. The 99% confidence interval for AAAD was 7.12-7.82 mm. There was no significant correlation between AAAD and AALB/AARA and AALD and AALB/AARA. CONCLUSION The AAAD was less than 7.12 mm or much than 7.82 mm that suggested a possible instability in the atlantoaxial joint and could help the diagnosis of the atlantoaxial instability in children no more than 8 years old. There was no difference between the mean AAAD of pediatric patients no more than 8 years old in different age and gender groups.

    更新日期:2019-11-01
  • Detection of occult abnormalities in the deep gray matter nuclei of neonates with punctate white matter lesions by magnetic resonance spectroscopy.
    Neuroradiology (IF 2.504) Pub Date : 2019-09-13
    Qinli Sun,Miaomiao Wang,Xianjun Li,Chao Jin,Hui Zhang,Yuli Zhang,Fan Wu,Zhe Liu,Xiaoyu Wang,Congcong Liu,Xiaocheng Wei,Duan Xu,Jian Yang

    PURPOSE Punctate white matter lesions (PWML) are common in preterm neonates and have also been reported in the full term. While most studies focus on white matter abnormalities, gray matter (GM) alterations are generally ignored due to the lack of abnormalities on conventional MRI. This study aims to investigate whether magnetic resonance spectroscopy is a sensitive and practical method to detect occult alterations of deep GM nuclei in these neonates. METHODS Neonates with PWML and controls with no MRI abnormalities were retrospectively studied. Apparent diffusion coefficient values and metabolic ratios (Cho/Cr, NAA/Cho, and NAA/Cr) in the lenticular nucleus and the thalamus were compared between the PWML and control groups. RESULTS Forty-two neonates with PWML (grades I, II, and III contained 14, 21, and 7 subjects, respectively) and 50 controls were enrolled. Apparent diffusion coefficient values in the lenticular nucleus and the thalamus were not significantly different between the PWML and the control groups. The NAA/Cho ratio was significantly lower in the PWML group than in the control group in both regions, whereas a lower NAA/Cr ratio was only observed in the thalamus. Significantly lower ratios of NAA/Cho in both regions and NAA/Cr in the thalamus were detected in the grade II and III subgroup, whereas the thalamic NAA/Cho ratio was decreased in the grade I group compared with controls. CONCLUSIONS Magnetic resonance spectroscopy is a sensitive method for detecting the occult deep GM abnormalities for the study cohort of neonates with PWML when compared with subjects without PWML.

    更新日期:2019-11-01
  • Fractional anisotropy of the optic radiations correlates with the visual field after epilepsy surgery.
    Neuroradiology (IF 2.504) Pub Date : 2019-09-09
    João Paulo Sant Ana Santos de Souza,Gabriel Ayub,Pamela Castro Pereira,José Paulo Cabral Vasconcellos,Clarissa Yasuda,Andrei Fernandes Joaquim,Helder Tedeschi,Brunno Machado Campos,Fernando Cendes,Enrico Ghizoni

    PURPOSE This study assessed whether optic radiations (OR) microstructure after temporal lobe epilepsy (TLE) surgery correlated with visual field defects (VFD). METHODS Patients were subjected to diffusion tensor imaging (DTI) tractography of the OR and Humphrey perimetry after TLE surgery. We used Spearman's test to verify correlations between tractographic parameters and perimetry mean deviation. Tractographic variables were compared between patients with VFD or intact perimetry. Multiple logistic regression was applied between DTI and perimetry values. DTI sensitivity and specificity were assessed with a receiver operating characteristic (ROC) curve to evaluate VFD. RESULTS Thirty-nine patients had reliable perimetry and OR tractography. There was a significant correlation between (1) fractional anisotropy (FA) and both total (rho = 0.569, p = 0.0002) and quadrant (rho = 0.453, p = 0.0037) mean deviation and (2) radial diffusivity and total mean deviation (rho = - 0.350, p = 0.0286). There was no other significant correlation. Patients with VFD showed a significantly lower FA compared with patients with normal perimetry (p = 0.0055), and a 0.01 reduction in FA was associated with a 44% increase in presenting VFD after surgery (confidence interval, CI = 1.10-1.88; p = 0.0082). Using a FA of 0.457, DTI tractography showed a specificity of 95.2% and a sensitivity of 50% to detect VFD after surgery (area under the curve = 0.7619, CI = 0.6020-0.9218). CONCLUSION The postoperative OR microstructure correlated with visual loss after epilepsy surgery. DTI postoperative OR tractography may be helpful in evaluating VFD.

    更新日期:2019-11-01
  • Endovascular treatment of acute intracranial vertebrobasilar artery occlusion: a multicenter retrospective observational study.
    Neuroradiology (IF 2.504) Pub Date : 2019-09-05
    Tao Quan,Haiman Hou,Wenjun Xue,Guangzhou Yu,Hengfei Ma,Jiachen Sun,Sheng Guan,Yuming Xu,Haowen Xu

    PURPOSE This study aimed to evaluate prognostic parameters associated with favorable clinical prognosis and assess the feasibility and safety of three different treatment strategies in patients with acute intracranial vertebrobasilar artery occlusion (VBAO). METHODS A total of 159 patients with acute VBAO at 3 stroke centers between September 2015 and October 2018 were retrospectively analyzed. Eighty-nine patients underwent mechanical thrombectomy (MT) alone, 43 underwent MT with additional rescue angioplasty, and 27 underwent primary balloon angioplasty (without or with stenting). In patients treated with primary or rescue balloon angioplasty (without or with stenting), a low-dose intra-arterial tirofiban injection was used. The reperfusion status was assessed after the procedure, and the functional outcome was assessed at 90-day follow-up. The baseline characteristics and 90-day prognosis of three different treatment subgroups were comparatively analyzed. RESULTS Overall, successful reperfusion and a favorable outcome were achieved in 96.86% (154/159) and 46.54% (74/159) patients, respectively. The onset to puncture time (461.96 min vs 603.59 min, P = 0.000), procedure time (64.12 min vs 70.47 min, P = 0.007), and onset to reperfusion time (526.08 min vs 674.47 min, P = 0.000) were significantly shorter in patients with favorable outcomes than in those with poor outcomes. Among different endovascular treatment subgroups, no significant differences were found in successful reperfusion and 90-day outcome. Low-dose tirofiban did not increase the risk of symptomatic intracranial hemorrhage and the 90-day mortality in patients with acute VBAO. CONCLUSION Individualized endovascular treatment strategy for selected patients with acute VBAO could achieve satisfactory reperfusion rate and favorable prognosis.

    更新日期:2019-11-01
  • 更新日期:2019-11-01
  • Endovascular treatment in patients with large vessel occlusion: reduced mortality despite minimal penumbra.
    Neuroradiology (IF 2.504) Pub Date : 2019-08-30
    Philip Hoelter,Manuel Schmidt,Lorenz Breuer,Bernd Kallmünzer,Stefan Schwab,Arnd Doerfler,Tobias Engelhorn

    PURPOSE In patients with acute ischemic stroke (AIS) caused by large vessel occlusion (LVO), endovascular treatment (EVT) is highly effective for emergency revascularization. However, data on functional outcome are lacking for patients, which show no or minimal mismatch between ischemic core and penumbra. METHODS Forty-five patients with AIS due to LVO of the anterior circulation were retrospectively analyzed within 6 h since onset when administered to our department. In all patients, there was no relevant penumbra according to CT perfusion (CTP). Functional outcome, defined by the modified Rankin Scale (mRS) at 30 and 90 days, was analyzed according to LVO treatment (EVT versus non-EVT). Confounding was addressed by multivariable regression analyses. RESULTS mRS values at 30 days (p = 0.002) and 90 days (p = 0.005) after AIS occurrence were significantly lower in patients who had received EVT. There was no significant difference regarding good functional outcome, as measured by mRS of 0-2 at 30 (p = 0.432) and 90 days, respectively (p = 0.186). Mortality was significantly reduced in patients undergoing EVT at 30-day (p < 0.001) and at 90-day follow-up (p = 0.003), respectively. Multivariable regression analyses revealed that EVT was associated with reduced mortality at 30 (OR 0.091; CI (0.013-0.612); p = 0.014) and 90 days (OR 0.134; CI (0.021-0.857); p = 0.034) after AIS. CONCLUSIONS Despite a small and highly selected patient collective, our study indicates that AIS patients with minimal penumbra in CTP might benefit from EVT in terms of reduced mortality at 30 and 90 days after AIS. However, in this group of patients, we could not prove favorable functional outcome at 30 and 90 days, despite receiving EVT.

    更新日期:2019-11-01
  • Prediction of high proliferative index in pituitary macroadenomas using MRI-based radiomics and machine learning.
    Neuroradiology (IF 2.504) Pub Date : 2019-08-04
    Lorenzo Ugga,Renato Cuocolo,Domenico Solari,Elia Guadagno,Alessandra D'Amico,Teresa Somma,Paolo Cappabianca,Maria Laura Del Basso de Caro,Luigi Maria Cavallo,Arturo Brunetti

    PURPOSE Pituitary adenomas are among the most frequent intracranial tumors. They may exhibit clinically aggressive behavior, with recurrent disease and resistance to multimodal therapy. The ki-67 labeling index represents a proliferative marker which correlates with pituitary adenoma aggressiveness. Aim of our study was to assess the accuracy of machine learning analysis of texture-derived parameters from pituitary adenomas preoperative MRI for the prediction of ki-67 proliferation index class. METHODS A total of 89 patients who underwent an endoscopic endonasal procedure for pituitary adenoma removal with available ki-67 labeling index were included. From T2w MR images, 1128 quantitative imaging features were extracted. To select the most informative features, different supervised feature selection methods were employed. Subsequently, a k-nearest neighbors (k-NN) classifier was employed to predict macroadenoma high or low proliferation index. Algorithm validation was performed with a train-test approach. RESULTS Of the 12 subsets derived from feature selection, the best performing one was constituted by the 4 highest correlating parameters at Pearson's test. These all showed very good (ICC ≥ 0.85) inter-observer reproducibility. The overall accuracy of the k-NN in the test group was of 91.67% (33/36) of correctly classified patients. CONCLUSIONS Machine learning analysis of texture-derived parameters from preoperative T2 MRI has proven to be effective for the prediction of pituitary macroadenomas ki-67 proliferation index class. This might aid the surgical strategy making a more accurate preoperative lesion classification and allow for a more focused and cost-effective follow-up and long-term management.

    更新日期:2019-11-01
  • Radiomics approach for prediction of recurrence in skull base meningiomas.
    Neuroradiology (IF 2.504) Pub Date : 2019-07-22
    Yang Zhang,Jeon-Hor Chen,Tai-Yuan Chen,Sher-Wei Lim,Te-Chang Wu,Yu-Ting Kuo,Ching-Chung Ko,Min-Ying Su

    PURPOSE A subset of skull base meningiomas (SBM) may show early progression/recurrence (P/R) as a result of incomplete resection. The purpose of this study is the implementation of MR radiomics to predict P/R in SBM. METHODS From October 2006 to December 2017, 60 patients diagnosed with pathologically confirmed SBM (WHO grade I, 56; grade II, 3; grade III, 1) were included in this study. Preoperative MRI including T2WI, diffusion-weighted imaging (DWI), and contrast-enhanced T1WI were analyzed. On each imaging modality, 13 histogram parameters and 20 textural gray level co-occurrence matrix (GLCM) features were extracted. Random forest algorithms were utilized to evaluate the importance of these parameters, and the most significant three parameters were selected to build a decision tree for prediction of P/R in SBM. Furthermore, ADC values obtained from manually placed ROI in tumor were also used to predict P/R in SBM for comparison. RESULTS Gross-total resection (Simpson Grades I-III) was performed in 33 (33/60, 55%) patients, and 27 patients received subtotal resection. Twenty-one patients had P/R (21/60, 35%) after a postoperative follow-up period of at least 12 months. The three most significant parameters included in the final radiomics model were T1 max probability, T1 cluster shade, and ADC correlation. In the radiomics model, the accuracy for prediction of P/R was 90%; by comparison, the accuracy was 83% using ADC values measured from manually placed tumor ROI. CONCLUSIONS The results show that the radiomics approach in preoperative MRI offer objective and valuable clinical information for treatment planning in SBM.

    更新日期:2019-11-01
  • White matter alterations in adult with autism spectrum disorder evaluated using diffusion kurtosis imaging.
    Neuroradiology (IF 2.504) Pub Date : 2019-06-19
    Aki Hattori,Koji Kamagata,Eiji Kirino,Christina Andica,Shoji Tanaka,Akifumi Hagiwara,Shohei Fujita,Tomoko Maekawa,Ryusuke Irie,Kanako K Kumamaru,Michimasa Suzuki,Akihiko Wada,Masaaki Hori,Shigeki Aoki

    PURPOSE Autism spectrum disorder (ASD) is related to impairment in various white matter (WM) pathways. Utility of the recently developed two-compartment model of diffusion kurtosis imaging (DKI) to analyse axial diffusivity of WM is restricted by several limitations. The present study aims to validate the utility of model-free DKI in the evaluation of WM alterations in ASD and analyse the potential relationship between DKI-evident WM alterations and personality scales. METHODS Overall, 15 participants with ASD and 15 neurotypical (NT) controls were scanned on a 3 T magnetic resonance (MR) scanner, and scores for autism quotient (AQ), systemising quotient (SQ) and empathising quotient (EQ) were obtained for both groups. Multishell diffusion-weighted MR data were acquired using two b-values (1000 and 2000 s/mm2). Differences in mean kurtosis (MK), radial kurtosis (RK) and axial kurtosis (AK) between the groups were evaluated using tract-based spatial statistics (TBSS). Finally, the relationships between the kurtosis indices and personality quotients were examined. RESULTS The ASD group demonstrated significantly lower AK in the body and splenium of corpus callosum than the NT group; however, no other significant differences were identified. Negative correlations were found between AK and AQ or SQ, predominantly in WM areas related to social-emotional processing such as uncinate fasciculus, inferior fronto-occipital fasciculus, and inferior and superior longitudinal fasciculi. CONCLUSIONS Model-free DKI and its indices may represent a novel, objective method for detecting the disease severity and WM alterations in patients with ASD.

    更新日期:2019-11-01
  • Segment-specific progression of carotid artery atherosclerosis: a magnetic resonance vessel wall imaging study.
    Neuroradiology (IF 2.504) Pub Date : null
    MingmingLu,Fei Yuan,Lichen Zhang,Peng Peng,Huiyu Qiao,Jianming Cai,Xihai Zhao

    PURPOSE This study aimed to investigate the segment-specific progression of atherosclerotic carotid plaques using serial multi-contrast magnetic resonance (MR) imaging. METHODS Symptomatic patients with carotid 30-70% stenosis were recruited and underwent carotid MR vessel wall imaging at baseline and follow-up time point (≥ 6 months after baseline). The location of plaques was determined according to the maximum wall thickness located above or below carotid bifurcation. The baseline and changing characteristics of carotid plaques were compared between plaques above and below carotid bifurcation, and the risk factors for segment-specific plaque progression were analyzed with logistic regression. RESULTS Ninety-six carotid plaques from 73 patients (mean age 66.5 ± 11.4 years old) were eligible for statistical analysis. Compared with plaques located below carotid bifurcation, those above bifurcation had significantly greater stenosis at baseline (57.2 ± 13.0% vs. 50.4 ± 13.5%, p = 0.016, adjusted p = 0.005) and greater progression rate of carotid wall volume (35.2 ± 68.8 mm3/year vs. 4.2 ± 65.0 mm3/year, p = 0.026, adjusted p = 0.005) before and after adjusting for all clinical risk factors and baseline stenosis and wall volume of carotid arteries. Logistic regression showed that the related risk factors were age, hypertension, and smoke for the progression of plaques located above the bifurcation and age for plaques below the bifurcation, respectively. CONCLUSION Plaques located above the bifurcation of carotid arteries had greater annual progression and correlated with more cardiovascular risk factors compared with those located below the bifurcation.

    更新日期:2019-11-01
  • A practical protocol for shortening reconstruction time of volumetric data and imaging bilateral middle cerebral arteries for thrombectomy in acute ischemic stroke using an 80-row computed tomography scanner.
    Neuroradiology (IF 2.504) Pub Date : null
    Takahisa Mori,Kazuhiro Yoshioka

    Time-consuming reconstruction of volumetric data by area-detector-computed tomography (ADCT) scanning and narrow coverage of small-row ADCT may hinder volumetric scanning in acute stroke stage. To design a practical protocol of volumetric scanning for thrombectomy using an 80-row ADCT. An imaging protocol that focuses on the middle cerebral arteries by tilting the gantry of an 80-row ADCT with 0.5-mm-thick detectors can shorten the reconstruction time by 1.0-mm thickness scanning without subtraction. The reconstruction time of small volumetric data was 69 second. This practical protocol is applicable before thrombectomy in different stroke centres with narrow-coverage ADCT scanners.

    更新日期:2019-11-01
  • Comparison of different methods of thrombus permeability measurement and impact on recanalization in the INTERRSeCT multinational multicenter prospective cohort study.
    Neuroradiology (IF 2.504) Pub Date : null
    Henrik Gensicke,James W Evans,Fahad S Al Ajlan,Dar Dowlatshahi,Mohamed Najm,Ana L Calleja,Josep Puig,Sung-lI Sohn,Seong H Ahn,Alexandre Y Poppe,Robert Mikulik,Negar Asdaghi,Thalia S Field,Albert Jin,Talip Asil,Jean-Martin Boulanger,Michael D Hill,Mayank Goyal,Andrew M Demchuk,Bijoy K Menon,

    PURPOSE To compare the association of different measures of intracranial thrombus permeability on non-contrast computerized tomography (NCCT) and computed tomography angiography (CTA) with recanalization with or without intravenous alteplase. METHODS Patients with anterior circulation occlusion from the INTERRSeCT study were included. Thrombus permeability was measured on non-contrast CT and CTA using the following methods: [1] automated method, mean attenuation increase on co-registered thin (< 2.5 mm) CTA/NCCT; [2] semi-automated method, maximum attenuation increase on non-registered CTA/NCCT (ΔHUmax); [3] manual method, maximum attenuation on CTA (HUmax); and [4] visual method, residual flow grade. Primary outcome was recanalization with intravenous alteplase on the revised AOL scale (2b/3). Regression models were compared using C-statistic, Akaike (AIC), and Bayesian information criterion (BIC). RESULTS Four hundred eighty patients were included in this analysis. Statistical models using methods 2, 3, and 4 were similar in their ability to discriminate recanalizers from non-recanalizers (C-statistic 0.667, 0.683, and 0.634, respectively); method 3 had the least information loss (AIC = 483.8; BIC = 492.2). A HUmax ≥ 89 measured with method 3 provided optimal sensitivity and specificity in discriminating recanalizers from non-recanalizers [recanalization 55.4% (95%CI 46.2-64.6) when HUmax > 89 vs. 16.8% (95%CI 13.0-20.6) when HUmax ≤ 89]. In sensitivity analyses restricted to patients with co-registered CTA/NCCT (n = 88), methods 1-4 predicted recanalization similarly (C-statistic 0.641, 0.688, 0.640, 0.648, respectively) with Method 2 having the least information loss (AIC 104.8, BIC 109.8). CONCLUSION Simple methods that measure thrombus permeability are as reliable as complex image processing methods in discriminating recanalizers from non-recanalizers.

    更新日期:2019-11-01
  • Neuroimaging characteristics and long-term prognosis of myxoma-related intracranial diseases.
    Neuroradiology (IF 2.504) Pub Date : null
    Shuo Zhang,Qian Zhang,Hai Yu,Longqi Liu,Rujing Sun,Xiaowen Song,Xianzeng Tong,Yueshan Piao,Xin Chen,Jun Wu,Yong Cao,Shuo Wang,Jizong Zhao

    PURPOSE Myxoma-related intracranial diseases were rarely documented in history. The main purpose of our study is to provide a more comprehensive and detailed understanding of the pathogenesis, imaging features, surgical procedures and pathology of such patients through long-term follow-up. METHODS From March 2012 to July 2018, baseline information that included neuroimaging and neuropathology data from 12 cardiac myxoma patients with neurological symptoms were retrospectively analysed, and the treatment options were discussed. Nine patients underwent long-term postoperative follow-up. RESULTS Twelve cardiac myxoma patients with neurological symptoms were identified, and among them, 10 patients were postoperative patients who had undergone excision of cardiac myxoma, 5 patients had received craniotomy, and the others had received conservative treatment. Positive neuroimaging findings were found in all patients, including cerebral infarction (12/12, 100%), multiple intracranial aneurysms (8/12, 67%), and extravascular metastasis (6/12, 50%). After a long-term average follow-up of 27 months, an increased number of metastatic lesions or an enlargement of the intracranial aneurysms was found in 4 patients. CONCLUSIONS Neuroimaging findings of myxoma-related intracranial lesions were diversed and usually presented as multiple cerebral infarction, aneurysm formation, focal intracranial haemorrhage and space-occupying lesions. Progress is over a long period of time after primary tumour resection. It is necessary for patients to be regularly examined within 2 years after cardiac myxoma resection using MRI+CTA/MRA/DSA in order to be ruled out. Stable and effective chemotherapy drugs are urgently needed.

    更新日期:2019-11-01
  • Venous pathologies in paediatric neuroradiology: from foetal to adolescent life.
    Neuroradiology (IF 2.504) Pub Date : 2019-11-11
    Kshitij Mankad,Asthik Biswas,Maria Camilla Rossi Espagnet,Luke Dixon,Nihaal Reddy,Ai Peng Tan,Ozgur Oztekin,Felice D'Arco,Karuna Shekdar,Prakash Muthusami,Fergus Robertson,Stacy Goergen,Winston Chong

    The interpretation of cerebral venous pathologies in paediatric practice is challenging as there are several normal anatomical variants, and the pathologies are diverse, involving the venous system through direct and indirect mechanisms. This paper aims to provide a comprehensive review of these entities, as their awareness can avoid potential diagnostic pitfalls. We also propose a practical classification system of paediatric cerebral venous pathologies, which will enable more accurate reporting of the neuroimaging findings, as relevant to the underlying pathogenesis of these conditions. The proposed classification system comprises of the following main groups: arterio-venous shunting-related disorders, primary venous malformations and veno-occlusive disorders. A multimodal imaging approach has been included in the relevant subsections, with a brief overview of the modality-specific pitfalls that can also limit interpretation of the neuroimaging. The article also summarises the current literature and international practices in terms of management options and outcomes in specific disease entities.

    更新日期:2019-11-01
  • Atherosclerotic ICA stenosis coinciding with ICA asymmetry associated with Circle of Willis variations can mimic near-occlusion.
    Neuroradiology (IF 2.504) Pub Date : null
    Elias Johansson,Richard I Aviv,Allan J Fox

    Differentiating carotid near-occlusion (tight atherosclerotic stenosis causing distal artery size reduction) from conventional stenosis is the first step when grading carotid stenoses with NASCET method. The internal carotid artery (ICA) can be asymmetrically associated with Circle of Willis variations. When such ICA asymmetry coincides with stenosis, it may mimic near-occlusion. We studied ICA anatomical variant prevalence in 4042 consecutive CTA exams from all indications, 53 excluded due to carotid occlusion, 814 with any ≥ 50% steno-occlusive disease intra- or extracranially, 3228 without. Of the 3989 included cases, 568 (14%) had ICA asymmetry, of which 335 (59%) were from associated with Circle of Willis variations. Of 3228 patients without ≥ 50% stenosis or other steno-occlusive disease intra- and extracranially; 257 (8.0%) demonstrated ICA asymmetry associated with Circle of Willis variations, equally common among sexes and age unrelated and most frequently attributed to an ipsilateral A1 hypoplasia/aplasia, less often attributed to large contralateral posterior communicating artery. As ICA asymmetry associated with Circle of Willis variations are common, caution should be exercised diagnosing near-occlusion on asymmetry alone.

    更新日期:2019-11-01
  • Correction to: Percutaneous ozone nucleolysis for lumbar disc herniation.
    Neuroradiology (IF 2.504) Pub Date : 2019-07-12
    Mohamed Ezeldin,Marco Leonardi,Ciro Princiotta,Massimo Dall'olio,Mohammed Tharwat,Mohammed Zaki,Mohamed E Abdel-Wanis,Luigi Cirillo

    The published version of this article unfortunately contained a mistake. Affiliation 2 was presented incorrectly in the original article. The updated affiliation is Neuroradiology Unit, Bellaria Hospital, IRCCS Institute of Neurological Sciences, Bologna, Italy.

    更新日期:2019-11-01
  • Metal artifact reduction algorithm for image quality improvement of cone-beam CT images of medium or large cerebral aneurysms treated with stent-assisted coil embolization.
    Neuroradiology (IF 2.504) Pub Date : null
    Satoshi Murai,Masafumi Hiramatsu,Yuji Takasugi,Yu Takahashi,Naoya Kidani,Shingo Nishihiro,Yukei Shinji,Jun Haruma,Tomohito Hishikawa,Kenji Sugiu,Isao Date

    PURPOSE The aim of the present study was to assess image quality improvement using a metal artifact reduction (MAR) algorithm in cases of medium or large cerebral aneurysms treated with stent-assisted coil embolization (SAC), and to analyze factors associated with the usefulness of the MAR algorithm. METHODS We retrospectively evaluated the cone-beam computed tomography (CBCT) data sets of 18 patients with cerebral aneurysms treated with SAC. For subjective analysis, images of all cases with and without MAR processing were evaluated by five neurosurgeons based on four criteria using a five-point scale. For objective analysis, the CT values of all cases with and without MAR processing were calculated. In addition, we assessed factors associated with the usefulness of the MAR by analyzing the nine cases in which the median score for criterion 1 improved by more than two points. RESULTS MAR processing improved the median scores for all four criteria in 17/18 cases (94.4%). Mean CT values of the region of interest at the site influenced by metal artifacts were significantly reduced after MAR processing. The maximum diameter of the coil mass (< 17 mm; odds ratio [OR], 4.0; 95% confidence interval [CI], 1.2-13.9; p = 0.02) and vessel length covered by metal artifacts (< 24 mm; OR, 2.3; 95% CI, 1.1-4.7; p = 0.03) was significantly associated with the usefulness of the MAR. CONCLUSIONS This study suggests the feasibility of a MAR algorithm to improve the image quality of CBCT images in patients who have undergone SAC for medium or large aneurysms.

    更新日期:2019-11-01
  • Impact of brain tumors and radiotherapy on the presence of gadolinium in the brain after repeated administration of gadolinium-based contrast agents: an experimental study in rats.
    Neuroradiology (IF 2.504) Pub Date : 2019-07-13
    Gregor Jost,Thomas Frenzel,Janina Boyken,Hubertus Pietsch

    PURPOSE To investigate the impact of blood-brain barrier (BBB) alterations induced by an experimental tumor and radiotherapy on MRI signal intensity (SI) in deep cerebellar nuclei (DCN) and the presence of gadolinium after repeated administration of a linear gadolinium-based contrast agent in rats. METHODS Eighteen Fischer rats were divided into a tumor (gliosarcoma, GS9L model), a radiotherapy, and a control group. All animals received 5 daily injections (1.8 mmol/kg) of gadopentetate dimeglumine. For tumor-bearing animals, the BBB disruption was confirmed by contrast-enhanced MRI. Animals from the tumor and radiation group underwent radiotherapy in 6 fractions of 5 Gray. The SI ratio between DCN and brain stem was evaluated on T1-weigthed MRI at baseline and 1 week after the last administration. Subsequently, the brain was dissected for gadolinium quantification by inductively coupled plasma-mass spectrometry. Statistical analysis was done with the Kruskal-Wallis test. RESULTS An increased but similar DCN/brain stem SI ratio was found for all three groups (p = 0.14). The gadolinium tissue concentrations (median, nmol/g) were 6.7 (tumor), 6.3 (radiotherapy), and 6.8 (control) in the cerebellum (p = 0.64) and 17.8/14.6 (tumor), 20.0/18.9 (radiotherapy), and 17.8/15.9 (control) for the primary tumor (p = 0.98) and the contralateral hemisphere (p = 0.41) of the cerebrum, respectively. CONCLUSION An experimental brain tumor treated by radiotherapy or radiotherapy alone did not alter DCN signal hyperintensity and gadolinium concentration in the rat brain 1 week after repeated administration of gadopentetate. This suggests that a local BBB disruption does not affect the amount of retained gadolinium in the brain.

    更新日期:2019-11-01
  • Risk factors of intracranial hemorrhage after mechanical thrombectomy of anterior circulation ischemic stroke.
    Neuroradiology (IF 2.504) Pub Date : 2019-02-20
    Ulf Neuberger,Philipp Kickingereder,Silvia Schönenberger,Simon Schieber,Peter A Ringleb,Martin Bendszus,Johannes Pfaff,Markus A Möhlenbruch

    PURPOSE Intracranial hemorrhage (ICH) is a potentially severe complication after mechanical thrombectomy (MT). Here, we investigated risk factors for the occurrence of any and symptomatic ICH after MT due to large-vessel occlusion of the anterior circulation. METHODS Consecutive patients with acute ischemic anterior circulation stroke with large-vessel occlusion undergoing MT were analyzed. ICH was categorized according to the Heidelberg Bleeding Classification. Forty-three procedural and clinical parameters were analyzed using univariate tests and multivariate logistic regressions. RESULTS Of 612 patients, any ICH was detected in 195 (31.9%), while 27 (4.4%) developed a symptomatic ICH. Infarct size > 1/3 of vascular territory in control imaging (OR 2.18, 95% CI 1.45-3.21), higher serum glucose levels (OR 1.23 for change of 15 units mg/dL, 95% CI 1.10-1.39), and higher thrombectomy maneuver count (OR 1.21, 95% CI 1.11-1.32) were significantly associated with a higher risk of developing any ICH compared to no ICH. Wake-up strokes (OR 3.99, 95% CI 1.38-11.60), transfer from an external clinic (OR 3.04, 95% CI 1.24-7.48), and higher serum glucose levels (OR 1.22 for change of 15 units mg/dL, 95% CI 1.05-1.42) were revealed as independent risk factors for development of symptomatic ICH compared to no symptomatic ICH. Patients with no infarct demarcation (OR 0.10, 95% CI 0.01-0.80) and complete recanalization (OR 0.57, 95% CI 0.37-0.86) showed a lower risk of developing any ICH. CONCLUSION Wake-up strokes and patients who are treated within a drip-and-ship concept are especially vulnerable for symptomatic ICH, while complete recanalization, contrary to subtotal recanalization only, was revealed as a protective factor against ICH.

    更新日期:2019-11-01
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