The latest medical research on Endovascular Surgical Neuroradiology
The research magnet gathers the latest research from around the web, based on your specialty area. Below you will find a sample of some of the most recent articles from reputable medical journals about endovascular surgical neuroradiology gathered by our medical AI research bot.
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Request AccessThe eagle-wing finding in FP-CIT SPECT, as a characteristic finding in patients with DESH- type iNPH.
NeuroradiologyAlthough dopamine transporter (DAT) imaging has been reported to be useful for differentiating idiopathic Normal Pressure Hydrocephalus (iNPH) from its mimics, the radiological findings of DAT imaging in iNPH have not been established. We investigated [123I] N-ω-fluoropropyl-2β-carboxymethoxy-3β-(4-iodophenyl) nortropane (FP-CIT) single photon emission computed tomography (SPECT) images from patients with disproportionately enlarged subarachnoid-space hydrocephalus (DESH)-type iNPH to understand the characteristics of DAT images of iNPH.
We retrospectively collected 11 DESH-type iNPH patients without comorbidities who underwent FP-CIT SPECT imaging. The patients' FP-CIT SPECT were examined using both visual and quantitative evaluations. Visual assessment used Kahraman et al.'s five-step grading, and quantitative assessment used DaTView and MIM software to calculate specific binding ratios (SBRs) for four volumes of interest (VOIs): the entire striatum, caudate nucleus, anterior putamen, and posterior putamen. Intergroup comparisons were made between the DESH group and a normal control (NC) group adjusted for age and sex.
The visual assessment classified 91% of DESH patients as showing grade 4 'eagle-wing' on FP-CIT SPECT, with a Kappa coefficient of 0.601. The median SBR was lower in the DESH group than in the NC group for all four VOIs, and significantly lower in the anterior and posterior putamen (p < 0.05).
In DESH-type iNPH, FP-CIT SPECT imaging typically shows the 'eagle-wing' finding due to decreased DAT concentration in the putamen. Our results enhance the utility of FP-CIT SPECT in diagnosing iNPH and distinguishing it from mimics.
Cost-Effectiveness of Nonoperative Management vs Upfront Laparoscopic Appendectomy for Pediatric Uncomplicated Appendicitis Over 1 Year.
American College of SurgeonsNon-operative management (NOM) with antibiotics alone for pediatric uncomplicated appendicitis is accepted to be safe and effective. However, the relative cost-effectiveness of this approach compared to appendectomy remains unknown. We aimed to evaluate the cost-effectiveness of non-operative versus operative management for pediatric uncomplicated acute appendicitis.
A trial-based real-world economic evaluation from the healthcare sector perspective was performed using data collected from a multi-institutional non-randomized controlled trial investigating NOM versus surgery. The time horizon was 1 year, with costs in 2023 US dollars. Ratio of costs-to-charges (RCC)-based data for the initial hospitalization, readmissions, and unplanned emergency department visits were extracted from the Pediatric Health Information System (PHIS). Utility data were derived from patient-reported disability days and health-related quality-of-life scores. Multiple scenarios and one-way deterministic and probabilistic sensitivity analyses accounted for parameter uncertainty. Willingness-to-pay (WTP) threshold was set at $100,000 per quality-adjusted life year (QALY) or disability-adjusted life year (DALY). Primary outcome measures included total and incremental mean costs, QALY, DALY, and incremental cost-effectiveness ratios (ICERs).
Of 1,068 participants, 370 (35%) selected NOM and 698 (65%) selected urgent laparoscopic appendectomy. Operative management cost an average of $9,791/patient and yielded an average of 0.884 QALYs while NOM cost an average of $8,044/patient and yielded an average of 0.895 QALYs. NOM was both less costly and more effective in base case and scenario analyses using disability days and alternate methods of calculating utilities.
NOM is cost-effective compared to laparoscopic appendectomy for pediatric uncomplicated appendicitis over 1 year.
Fetal torcular pseudomass and development of the dural venous sinuses: insights from 2D TOF MR angiography.
NeuroradiologyThe described evolution in prenatal and postnatal periods appears to support the hypothesis that the torcular pseudomass (TP) is probably a physiological, highly frequent and transient developmental finding. Neverthless, it remains to be determined whether TP has any relation with the final anatomy of the adjacent venous sinuses or any anatomic variants. We aimed to explore the relation of the TP with the adjacent dural venous anatomy/anatomic variants in the prenatal period, using MR angiography (2D TOF MRA).
We conducted a single centre retrospective study (September 2018-April 2024), by selecting all the fetal brain MRIs with MRA acquisition (2D TOF). Two neuroradiologists independently reviewed all MRIs, assessing the TP anatomy and adjacent venous sinuses.
Forty-five brain MRIs were obtained, from pregnant women with median maternal age of 31 years, and a median gestational age of 31 weeks. At least one anatomic variant of the venous drainage system was present in 48.9% of cases (n = 22), mainly a venous drainage dominance (40%). The TP was present in 75.6% of cases; it was focal and bulky in 10 cases each, and crescentic in the remainder; 70.6% were median/symmetric and 29.4% were left paramedian. We found a significant association of TP position and TP category; all of those with lateralization were left-sided, with a large proportion (80%) being bulky. The TP position was significantly associated with a pattern of right venous drainage dominance.
We have provided an assessment of the relationship of the TP with the surrounding venous anatomy, particularly regarding its correlation with anatomic variants.
Changes in the prognosis of CADASIL over time: a 23-year study in 555 individuals.
Neurology, Neurosurgery and PsychiatryCerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is the most common monogenic form of stroke and is associated with early-onset stroke and dementia. Whether its clinical phenotype is becoming milder with better risk factor treatments and other care improvements is unknown. In a large longitudinal CADASIL cohort, we determined whether the prognosis has changed over 23 years.
Patients were identified from the Cambridge CADASIL register and the UK Familial stroke study. Change in age at stroke over the time of recruitment was determined using linear mixed-effects model, and the impact of genetic and vascular risk factors on stroke and dementia risk was further evaluated using Cox proportional hazard regression.
A total of 555 patients with CADASIL were recruited between 2001 and 2023. The age of stroke onset significantly increased over time (p<0.001), with the mean age of stroke onset for patients recruited before 2016 (n=265) at 46.7±9.2 years and 51.6±9.5 years for those recruited since 2016 (n=290). Patients recruited since 2016 had lower risks of both stroke (HR 0.36, 95% CI 0.26 to 0.50, p<0.001) and dementia (HR 0.43, 95% CI 0.19 to 0.99, p=0.046) after adjusting for sex, hypertension history, smoking status, epidermal growth factor-like repeat position and calendar effect.
The clinical phenotype of CADASIL is improving. While this may be partly explained by reduced vascular risk factors such as smoking and the identification of milder cases, differences persisted after controlling for risk factors and mutation sites. These updated risk estimates should be used when counselling patients with CADASIL on prognosis.
Visualizing the association between the location and prognosis of isocitrate dehydrogenase wild-type glioblastoma: a voxel-wise Cox regression analysis with open-source datasets.
NeuroradiologyThis study examined the correlation between tumor location and prognosis in patients with glioblastoma using magnetic resonance images of various isocitrate dehydrogenase (IDH) wild-type glioblastomas from The Cancer Imaging Archive (TCIA). The relationship between tumor location and prognosis was visualized using voxel-wise Cox regression analysis.
Participants with IDH wild-type glioblastoma were selected, and their survival and demographic data and tumor characteristics were collected from TCIA datasets. Post-contrast-enhanced T1-weighted imaging, T2-fluid attenuated inversion recovery imaging, and tumor segmentation data were also compiled. Following affine registration of each image and tumor segmentation region of interest to the MNI standard space, a voxel-wise Cox regression analysis was conducted. This analysis determined the association of the presence or absence of the tumor with the prognosis in each voxel after adjusting for the covariates.
The study included 769 participants of 464 men and 305 women (mean age, 63 years ± 12 [standard deviation]). The hazard ratio map indicated that tumors in the medial frontobasal region and around the third and fourth ventricles were associated with poorer prognoses, underscoring the challenges of complete resection and treatment accessibility in these areas regardless of the tumor volume. Conversely, tumors located in the right temporal and occipital lobes had favorable prognoses.
This study showed an association between tumor location and prognosis. These findings may assist clinicians in developing more precise and effective treatment plans for patients with glioblastoma to improve their management.
Interhypothalamic adhesions: prevalence, structure, and location-based classification map in pediatric patients undergoing MRI.
NeuroradiologyInterhypothalamic adhesions (IHAs) have been reported only in the pediatric population, with unknown prevalence and histological composition. We aim to demonstrate their prevalence, assess their persistence through longitudinal imaging, classify IHAs by anatomical distribution, explore their structure, and report associated pathologies.
A retrospective review was conducted on consecutive pediatric brain MRI studies obtained between January 2012, and December 2013. The presence of an IHA was only confirmed when observed on at least two planes. For each IHA, cross-sectional area was calculated, and signal intensities were measured at the center on sagittal T2WIs. Signal intensities were also measured in both cerebral white matter and gray matter for normalization and comparison. Patient demographics and clinical information were collected from electronic charts.
Out of 1550 patients (0-17.9 years), 33 (19 males, 14 females) had an IHA, resulting in a 2.13% prevalence. Follow-up images were available for 19 IHA-positive patients, and IHAs were again seen in 92% of the follow-up scans (71/77). Normalized IHA signal highly correlated with normalized gray matter signal (r = 0.83, P < 0.001), but not with normalized white matter signal (r = -0.16, p = 0.494). Common co-occurring pathologies included hydrocephalus (n = 9), prematurity (n = 8), and corpus callosum abnormalities (n = 7). All type 3 IHAs (3/3) were accompanied by pituitary pathologies.
IHAs have a prevalence of 2.13% in our cohort, and the majority persist in longitudinal studies. They showed gray matter signal intensity and Type 3 IHAs exclusively accompanied pituitary abnormalities.
Prevalence of epilepsy: a population-based cohort study in Denmark with comparison to Global Burden of Disease (GBD) prevalence estimates.
Neurology, Neurosurgery and PsychiatryThe Global Burden of Disease Study (GBD) produces prevalence estimates for 'idiopathic epilepsy' (ie, of unknown aetiology) and 'secondary epilepsy' (ie, with known aetiology) but does not report prevalence by underlying aetiologies for 'secondary epilepsy'.
We used nationwide, population-based register data from Denmark to identify underlying causes of epilepsy and their contribution to prevalence of 'secondary epilepsy' and compared with global prevalence data from GBD 2019. We identified all persons with a hospital-based epilepsy diagnosis and a filled prescription for antiseizure medication between 1 January 2009 and 31 December 2018. Epilepsy was categorised into 'idiopathic' or 'secondary' and 'total epilepsy' as the sum of the two epilepsy categories.
On 31 December 2018, a total of 5 784 284 individuals (49.7% males) were living in Denmark including 40 336 with epilepsy (51.5% males). Perinatal conditions, traumatic brain injury, brain tumours and stroke were prominent underlying causes of 'secondary epilepsy'. The prevalence of 'total epilepsy' in Denmark was 697 (95% CI 691 to 704) per 100 000 population (264 (95% CI 260 to 269) for 'secondary epilepsy' and 433 (95% CI 428 to 438) for 'idiopathic epilepsy'). In the GBD 2019 Study, the prevalence of 'total epilepsy' in 2018 was 682 (95% uncertainty interval (UI) 586 to 784) per 100 000 population (359 (95% UI 324-397) for 'secondary epilepsy' and 324 (95% UI 249 to 404) for 'idiopathic epilepsy').
Prevalence estimates of 'total epilepsy', 'idiopathic epilepsy' and 'secondary epilepsy' in Denmark align with the GBD 2019 estimates. In future studies, it is suggested to explicitly include all types of epilepsy, including 'secondary epilepsy', which is currently estimated as sequelae (consequences) of underlying diseases.
Eliminating Error in Central Line Scheduling and Placement Using Quality Improvement Methods.
American College of SurgeonsThe Joint Commission defines a sentinel event as "surgery or other invasive procedure performed at the wrong site, on the wrong patient, or that is the wrong (unintended) procedure for a patient regardless of the type of procedure or the magnitude of the outcome." At our institution, we observed a low but consistent rate of incorrect surgical line placement for pediatric patients with cancer.
Following quality improvement methodology and using the resources available on a large academic medical campus we designed and implemented a new multi-factorial process to schedule and place surgical central lines for pediatric patients with cancer. Changes included re-defining responsibilities, adding staff, and redesigning the process with workflows supported by modifications to the electronic medical record. Our primary outcome measures were incorrect central line placement or near miss event per quarter and days between these events.
After implementation the rate of incorrect line placement and near miss events was reduced to zero with 1018 days since the last incorrect line placement.
As a result of our multi-factorial quality improvement initiative in the scheduling and placement of central lines, we were able to eliminate surgical line placement sentinel events and improve care for pediatric patients with cancer.
Automated assessment of brain MRIs in multiple sclerosis patients significantly reduces reading time.
NeuroradiologyAssessment of multiple sclerosis (MS) lesions on magnetic resonance imaging (MRI) is tedious, time-consuming, and error-prone. We evaluate whether assessment of new, expanding, and contrast-enhancing MS lesions can be done more time-efficiently by radiologists with assistance of artificial intelligence (AI).
Baseline and three follow-up (FU) MRIs of thirty-five consecutive patients diagnosed with MS were assessed by a radiologist manually, and with assistance of an AI-tool. Results were discussed with a consultant neuroradiologist and time metrics were evaluated.
The mean reading time for the resident radiologist was 9.05 min (95CI: 6.85-11:25). With AI-assistance, the reading time was reduced by 2.83 min (95CI: 3.28-2.41, p < 0.001). The reading decreased steadily from baseline to FU3 for the resident radiologist (9.85 min baseline, 9.21 FU1, 8.64 FU2 and 8.44 FU3, p < 0.001). Assistance of AI further remarkably decreased reading times during follow-ups (3.29 min FU1, 3.92 FU2, 3.79 FU3, p < 0.001) but not at baseline (0.26 min, p = 0.96). The baseline reading time of the resident radiologist was 5.04 min (p < 0.001), with each lesion adding 0.14 min (p < 0.001). There was a substantial decrease in the baseline reading time from 5.04 min to 1.59 min (p = 0.23) with AI-assistance. Discussion of the reading results of the resident with the neuroradiology consultant (as usual in clinical routine) was exemplary done for FU-3 MRIs and added another 3 min (CI:2.27-3.76) to the reading time without AI-assistance.
We found that AI-assisted reading of MRIs of patients with MS may be faster than evaluating these MRIs without AI-assistance.
Real-time measurement of radiation exposure in interventional radiologists during CT-guided intrathecal injections of nusinersen.
NeuroradiologySome patients with spinal muscular atrophy and scoliosis require CT guidance during injections of nusinersen. The radiation applied to the operator in such procedures becomes an important issue in terms of staff health and safety. The aim of the study was to assess the operator's radiation exposure during CT-guided nusinersen injections in patients with spinal muscular atrophy and scoliosis.
Consecutive 40 CT-guided nusinersen injections were analyzed in terms of operator's radiation exposure measured in real time.
The median radiation dose measured under the physician's lead apron and patient dose in terms of DLP was 0.20 µSv and 31.90 mGy*cm respectively. The radiation doses were significantly higher (p = 0.047) in patients with spinal instrumentation.
The results show that CT-guided nusinersen injection is a relatively safe procedure in terms of operator's radiation exposure. This can allow for interventional radiologists to perform more procedures without exceeding their annual dose limit.
FET PET to differentiate between post-treatment changes and recurrence in high-grade gliomas: a single center multidisciplinary clinic controlled study.
NeuroradiologyThe clinico-radiological dilemma in post-treatment high-grade gliomas, between disease recurrence (TR) and treatment-related changes (TRC), still persists. FET (Fluoro-ethyl-tyrosine) PET has been extensively used as problem-solving modality for cases where MR imaging is inconclusive. We incorporated a systematic imaging and clinical follow-up algorithm in a multi-disciplinary clinic (MDC) setting to analyse our cohort of FET PET in post-treatment gliomas.
We retrospectively analyzed 171 patients of post-treatment grade III and IV glioma with equivocal findings on MRI. 185-222 MBq of 18 F-FET was injected and dedicated static imaging of brain was performed at 20 min. TBR (Tumor to background ratio) was used as semi-quantitative parameter. Cutoff of 2.5 was used for image interpretation. Imaging findings were confirmed with histopathological diagnosis, wherever available or in a multidisciplinary joint clinic based on serial imaging.
121 of 171 patients showed recurrent disease on FET PET, on follow up, 109 were confirmed with recurrence; 7 patients showed TRC, whereas 5 were treated with bevacizumab, with no further clinico-radiological deterioration, thus confirming TRC. 50 patients showed TRC on FET PET, on follow up on follow up, 40 were confirmed as true-negative. 10 patients who showed TBR less than 2.5 had confirmed TR on subsequent MR imaging. The overall sensitivity and specificity was 91.6 and 76.9% respectively, with a diagnostic accuracy of 87.13%.
There is potential for FET PET to be used along with MRI in the post treatment algorithm of high-grade glial tumors.
Diagnostic accuracy of radiomics and artificial intelligence models in diagnosing lymph node metastasis in head and neck cancers: a systematic review and meta-analysis.
NeuroradiologyHead and neck cancers are the seventh most common globally, with lymph node metastasis (LNM) being a critical prognostic factor, significantly reducing survival rates. Traditional imaging methods have limitations in accurately diagnosing LNM. This meta-analysis aims to estimate the diagnostic accuracy of Artificial Intelligence (AI) models in detecting LNM in head and neck cancers.
A systematic search was performed on four databases, looking for studies reporting the diagnostic accuracy of AI models in detecting LNM in head and neck cancers. Methodological quality was assessed using the METRICS tool and meta-analysis was performed using bivariate model in R environment.
23 articles met the inclusion criteria. Due to the absence of external validation in most studies, all analyses were confined to internal validation sets. The meta-analysis revealed a pooled AUC of 91% for CT-based radiomics, 84% for MRI-based radiomics, and 92% for PET/CT-based radiomics. Sensitivity and specificity were highest for PET/CT-based models. The pooled AUC was 92% for deep learning models and 91% for hand-crafted radiomics models. Models based on lymph node features had a pooled AUC of 92%, while those based on primary tumor features had an AUC of 89%. No significant differences were found between deep learning and hand-crafted radiomics models or between lymph node and primary tumor feature-based models.
Radiomics and deep learning models exhibit promising accuracy in diagnosing LNM in head and neck cancers, particularly with PET/CT. Future research should prioritize multicenter studies with external validation to confirm these results and enhance clinical applicability.
