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A model with multiple intracranial aneurysms: possible hemodynamic mechanisms of aneurysmal initiation, rupture and recurrence

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中华神经外科杂志(英文) 2024年第2期10卷 1-8页

作者： Li Wenqiang Wang Chao Wang Yanmin Zhao Yapeng Yang Xinjian Liu Xianzhi Liu Jian Department of Interventional neuroradiology and Neurosurgery Beijing Neurosurgical Institute and Beijing Tiantan Hospital Beijing China Department of Neurosurgery The First Affiliated Hospital of Zhengzhou University Zhengzhou China

Background Hemodynamic factors play an important role in aneurysm initiation, growth, rupture, and recurrence, while the mechanism of the hemodynamic characteristics is still controversial. A unique model of multiple aneurysms (initiation, growth, rupture, and recurrence) is helpful to avoids the confounders and further explore the possible hemodynamic mechanisms of aneurysm in different states.Methods We present a model with multiple aneurysms, and including the states of initiation, growth, rupture, and recurrence, discuss the proposed mechanisms, and describe computational fluid dynamic model that was used to evaluate the likely hemodynamic effect of different states of the aneurysms.Results The hemodynamic analysis suggests that high flow impingement and high WSS distribution at normal parent artery was found before aneurysmal initiation. The WSS distribution and flow velocity were decreased in the new sac after aneurysmal growth. Low WSS was the risk hemodynamic factor for aneurysmal rupture. High flow concentration region on the neck plane after coil embolization still marked in recanalized aneurysm.Conclusions Associations have been identified between high flow impingement and aneurysm recanalization, while low WSS is linked to the rupture of aneurysms. High flow concentration and high WSS distribution at normal artery associated with aneurysm initiation and growth, while after growth, the high-risk hemodynamics of aneurysm rupture was occurred, which is low WSS at aneurysm dome.

关键词： Multiple intracranial aneurysms Hemodynamic Aneurysm initiation and growth Rupture Recurrence

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Potential applications of 7 Tesla magnetic resonance imaging in paediatric neuroimaging:Feasibility and challenges

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World Journal of Clinical Pediatrics 2024年第2期13卷 1-6页

作者： Arosh S Perera Molligoda Arachchige Letterio S Politi Final Year Medical Student Faculty of MedicineHumanitas UniversityPieve Emanuele 20089Italy Department of neuroradiology IRCCS Humanitas Research HospitalRozzano 20089MilanItaly Department of Biomedical Sciences Humanitas UniversityPieve Emanuele 20072MilanItaly

The integration of 7 Tesla magnetic resonance imaging(7 T MRI)in adult patients has marked a revolutionary stride in radiology.In this article we explore the feasibility of 7 T MRI in paediatric practice,emphasizing its feasibility,applications,challenges,and safety considerations.The heightened resolution and tissue contrast of 7 T MRI offer unprecedented diagnostic accuracy,particularly in neuroimaging.Applications range from neuro-oncology to neonatal brain imaging,showcasing its efficacy in detecting subtle structural abnormalities and providing enhanced insights into neurological conditions.Despite the promise,challenges such as high cost,discomfort,and safety concerns necessitate careful consideration.Research suggests that,with precautions,7 T MRI is feasible in paediatrics,yet ongoing studies and safety assessments are imperative.

关键词： 7 Tesla magnetic resonance imaging Pediatric imaging Feasibility Challenges

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Generative pretrained transformer 4:an innovative approach to facilitate value-based healthcare

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Intelligent Medicine 2024年第1期4卷 10-15页

作者： Han Lyu Zhixiang Wang Jia Li Jing Sun Xinghao Wang Pengling Ren Linkun Cai Zhenchang Wang Max Wintermark Department of Radiology Capital Medical University Affiliated Beijing Friendship HospitalBeijing 100050China Department of Medical Imaging Capital Medical University Affiliated Beijing Friendship HospitalBeijing 100050China School of Biological Science and Medical Engineering Beihang UniversityBeijing 100191China Department of neuroradiology University of Texas MD Anderson CenterHoustonTX 77030USA

Objective Appropriate medical imaging is important for value-based care.We aim to evaluate the performance of generative pretrained transformer 4(GPT-4),an innovative natural language processing model,providing appropriate medical imaging automatically in different clinical scenarios.Methods Institutional Review Boards(IRB)approval was not required due to the use of nonidentifiable data.Instead,we used 112 questions from the American College of Radiology(ACR)Radiology-TEACHES Program as prompts,which is an open-sourced question and answer program to guide appropriate medical imaging.We included 69 free-text case vignettes and 43 simplified cases.For the performance evaluation of GPT-4 and GPT-3.5,we considered the recommendations of ACR guidelines as the gold standard,and then three radiologists analyzed the consistency of the responses from the GPT models with those of the ACR.We set a five-score criterion for the evaluation of the consistency.A paired t-test was applied to assess the statistical significance of the findings.Results For the performance of the GPT models in free-text case vignettes,the accuracy of GPT-4 was 92.9%,whereas the accuracy of GPT-3.5 was just 78.3%.GPT-4 can provide more appropriate suggestions to reduce the overutilization of medical imaging than GPT-3.5(t=3.429,P=0.001).For the performance of the GPT models in simplified scenarios,the accuracy of GPT-4 and GPT-3.5 was 66.5%and 60.0%,respectively.The differences were not statistically significant(t=1.858,P=0.070).GPT-4 was characterized by longer reaction times(27.1 s in average)and extensive responses(137.1 words on average)than GPT-3.5.Conclusion As an advanced tool for improving value-based healthcare in clinics,GPT-4 may guide appropriate medical imaging accurately and efficiently。

关键词： Generative pretrained transformer 4 model Natural language processing Medical imaging Appropriateness

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Pseudoaneurysm formation following transarterial embolization of traumatic carotid-cavernous fistula with detachable balloon:An institutional cohort long-term study

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World Journal of Radiology 2024年第4期16卷 94-108页

作者： Prasert Iampreechakul Korrapakc Wangtanaphat Songpol Chuntaroj Yodkhwan Wattanasen Sunisa Hangsapruek Punjama Lertbutsayanukul Pimchanok Puthkhao Somkiet Siriwimonmas Department of Neurosurgery Neurological Institute of ThailandBangkok 10400Thailand Department of neuroradiology Neurological Institute of ThailandBangkok 10400Thailand Department of Medical Services Neurological Institute of ThailandBangkok 10400Thailand Department of Radiology Bumrungrad International HospitalBangkok 10110Thailand

BACKGROUND The goal of therapy for traumatic carotid-cavernous fistula(TCCF)is the elimination of fistula while maintaining patency of the parent artery.The treatment for TCCF has evolved from surgery to endovascular management using detachable balloons,coils,liquid embolic agents,covered stents,or flow-diverter stent through arterial or venous approaches.Despite the withdrawal of detachable balloons from the market in the United States since 2004,transarterial embolization with detachable balloons has currently remained the best initial treatment for TCCF in several countries.However,the pseudoaneurysm formation following transarterial detachable balloon embolization has rarely been observed in long-term follow-up.AIM To determine the occurrence and long-term follow-up of pseudoaneurysm after transarterial detachable balloon for TCCF.METHODS Between January 2009 and December 2019,79 patients diagnosed with TCCF were treated using detachable latex balloons(GOLDBAL)of four sizes.Pseudoaneurysm sizes were stratified into five grades for analysis.Initial and follow-up assessments involved computed tomography angiography at 1 month,6 month,1 year,and longer intervals for significant cases.Clinical follow-ups occurred semi-annually for 2 years,then annually.Factors analyzed included sex,age,fistula size and location,and balloon size.RESULTS In our cohort of 79 patients treated for TCCF,pseudoaneurysms formed in 67.1%,with classifications ranging from grade 0 to grade 3;no grade 4 or giant pseudoaneurysms were observed.The majority of pseudoaneurysms did not progress in size,and some regressed spontaneously.Calcifications developed in most large pseudoaneurysms over 5-10 years.Parent artery occlusion occurred in 7.6%and recurrent fistulas in 16.5%.The primary risk factors for pseudoaneurysm formation were identified as the use of specific balloon sizes,with balloon SP and No.6 significantly associated with its occurrence(P=0.005 and P=0.002,respectively),whereas sex,age,fistula size,location,and the number of balloons

关键词： Pseudoaneurysm formation Traumatic carotid-cavernous fistula Direct carotid-cavernous fistula Transarterial embolization Detachable balloon Endovascular treatment Computed tomography angiography Long-term follow-up

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Pipeline Embolization Device for intracranial aneurysms presenting with mass effect:a large Chinese cohort

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Stroke & Vascular Neurology 2024年第1期9卷 50-58页

作者： Yang Zhao Junlin Lu Hongqi Zhang Tianxiao LI Donglei Song Sheng Guan Aisha Maimaitili Yunyan Wang Wenfeng Feng Yang Wang Jieqing Wan Guohua Mao Huaizhang Shi Xinjian Yang Jianmin Liu Yuanli Zhao Department of Neurosurgery Beijing Tiantan HospitalCapital Medical UniversityBeijingChina Department of Neurosurgery Peking University International HospitalBeijingChina Department of Neurosurgery West China HospitalSichuan UniversityChengduSichuanChina Department of Neurosurgery Xuanwu HospitalCapital Medical UniversityBeijingChina Department of Interventional neuroradiology Zhengzhou University People's HospitalZhengzhouHenanChina Department of Neurosurgery Shanghai Donglei Brain HospitalShanghaiChina Department of Interventional neuroradiology The First Affiliated Hospital of Zhengzhou UniversityZhengzhouHenanChina Department of Neurosurgery The First Affiliated Hospital of Xinjiang Medical UniversityUrumqiXinjiangChina Department of Neurosurgery Qilu Hospital of Shandong University QingdaoJinanShandongChina Department of Neurosurgery Nanfang HospitalSouthern Medical UniversityGuangzhouGuangdongChina Department of Neurosurgery The First Affiliated Hospital of Nanchang UniversityNanchangJiangxiChina Department of Neurosurgery Renji HospitalSchool of MedicineShanghai Jiao Tong UniversityShanghaiChina Department of Neurosurgery The Second Affiliated Hospital of Nanchang UniversityNanchangJiangxiChina Department of Neurosurgery The First Affiliated Hospital of Harbin Medical UniversityHarbinHeilongjiangChina Department of Neurosurgery Changhai HospitalNaval Medical UniversityShanghaiChina

Background Unruptured intracranial aneurysm treatment aims to reduce the risk of aneurysm rupture and bleeding,relieves symptoms and improve the quality of life for patients.This study aimed to assess the safety and efficacy of Pipeline Embolization Device(PED,Covidien/Medtronic,Irvine,CA)treatment for intracranial aneurysms presenting with mass effect in real-world settings.Methods We selected patients from the PED in China Post-Market Multi-Center Registry Study with mass effect presentation.The study endpoints included postoperative mass effect deterioration and mass effect relief at follow-up(3–36 months).We conducted multivariate analysis to identify factors associated with mass effect relief.Subgroup analyses by aneurysm location,size and form were also performed.Results This study included 218 patients with a mean age of 54.3±11.8 years and a female predominance of 74.0%(162/218).The postoperative mass effect deterioration rate was 9.6%(21/218).During a median follow-up period of 8.4 months,the mass effect relief rate was 71.6%(156/218).Notably,immediate aneurysm occlusion following treatment was significantly associated with mass effect relief(OR 0.392,95%CI,0.170 to 0.907,p=0.029).Subgroup analysis demonstrated that adjunctive coiling contributed to mass effect relief in cavernous aneurysms,while dense embolism impeded symptom relief in aneurysms<10mm and saccular aneurysms.Conclusions Our data confirmed the efficacy of PED in relieving mass effect.The findings of this study provide support for endovascular treatment to alleviate mass effect in unruptured intracranial aneurysms.Trial registration number NCT03831672.

关键词： aneurysm intracranial Irvine

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Recurrent Transient Ischemic Attacks Revealing Cerebral Amyloid Angiopathy: A Comprehensive Case

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World Journal of Neuroscience 2024年第1期14卷 33-36页

作者： Kenza Khelfaoui Tredano Houyam Tibar Kaoutar El Alaoui Taoussi Wafae Regragui Abdeljalil El Quessar Ali Benomar Neurology and Interventional neuroradiology Department Cheikh Zaied International Hospital International University Abulcasis of Health Sciences Rabat Morocco Neurology and Neurogenetics Department Specialties Hospital Ibn Sina University Hospital Mohammed 5 University Rabat Morocco

This case report investigates the manifestation of cerebral amyloid angiopathy (CAA) through recurrent Transient Ischemic Attacks (TIAs) in an 82-year-old patient. Despite initial diagnostic complexities, cerebral angiography-MRI revealed features indicative of CAA. Symptomatic treatment resulted in improvement, but the patient later developed a fatal hematoma. The discussion navigates the intricate therapeutic landscape of repetitive TIAs in the elderly with cardiovascular risk factors, emphasizing the pivotal role of cerebral MRI and meticulous bleeding risk management. The conclusion stresses the importance of incorporating SWI sequences, specifically when suspecting a cardioembolic TIA, as a diagnostic measure to explore and exclude CAA in the differential diagnosis. This case report provides valuable insights into these challenges, highlighting the need to consider CAA in relevant cases.

关键词： Cerebral Amyloid Angiopathy Transient Ischemic Attacks Recurrent Hemiparesis Susceptibility-Weighted Imaging Cardioembolic Origin Bleeding Risk Management Differential Diagnosis

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Acute coalescent mastoiditis in a 16-month-old child due to Streptococcus pneumoniae infection

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Journal of Acute Disease 2024年第1期13卷 36-39页

作者： Magdalena Pszczołowska Monika Morawska-Kochman Katarzyna Resler Katarzyna Pękalska Tomasz Zatoński Department and Clinic of Otolaryngology Head and Neck SurgeryWrocław Medical UniversityBorowska 213WrocławPoland Department of General Radiology Interventional Radiology and NeuroradiologyWrocław Medical UniversityBorowska 213WrocławPoland

Rationale:Acute otitis media is a common disease in early childhood,and is usually caused by Streptococcus pneumoniae(S.pneumoniae).Acute mastoiditis is a complication of acute otitis media and can involve not only the mucoperiosteum of the middle ear but can also spread to the periosteum by destroying the mastoid bone(acute coalescent mastoiditis).In addition,the infection can extend through the surrounding bones or the emissary veins beyond the mastoid’s air cells,leading to subperiosteal abscesses.Patient’s Concern:A 16-month-old female patient was hospitalized due to the purulent discharge of the left ear and the symptoms of right mastoiditis(swelling and redness of the skin).Diagnosis:Bilateral acute coalescent mastoiditis caused by S.pneumoniae infection.The computer tomography revealed bilateral bone destruction of the mastoid and abscesses found behind the auricle on both sides.Interventions:The patient underwent intravenous antibiotic therapy and surgical treatment.Outcomes:The patient was discharged 14 days after hospitalization with an improved condition.Lessons:Improperly treated acute coalescent mastoiditis can lead to extracranial and intracranial complications,sometimes serious and even life-threatening.Complications are prevalent in children under 2 years,in whom the disease progresses more rapidly and severely.The vaccination with a 13-valent vaccine may not result in sufficient immunity against S.pneumoniae,a predominant pathogen in children affected by acute coalescent mastoiditis.

关键词： Acute otitis media Acute coalescent mastoiditis Streptococcus pneumoniae Children Case report

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Balloon Angioplasty for Symptomatic Intracranial Artery Stenosis (BASIS): protocol of a prospective, multicentre, randomised, controlled trial

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Stroke & Vascular Neurology 2024年第1期9卷 66-74页

作者： Xuan Sun Ming Yang Dapeng Sun Guangge Peng Yiming Deng Xingquan Zhao Liping Liu Ning Ma Feng Gao Dapeng Mo Wengui Yu Yongjun Wang Yilong Wang Zhongrong Miao Department of Interventional neuroradiology Beijing Tiantan HospitalCapital Medical UniversityBeijingChina Department of Neurology Beijing Tiantan HospitalCapital Medical UniversityBeijingChina Department of Neurology Beijing Luhe HospitalCapital Medical UniversityBeijingChina Department of Neurology Comprehensive Stroke&Cerebrovascular CenterUniversity of California IrvineIrvineCaliforniaUSA Chinese Institute for Brain Research BeijingChina National Center for Neurological Diseases BeijingChina Advanced Innovation Center for Human Brain Protection Capital Medical UniversityBeijingChina China National Clinical Research Center for Neurological Diseases BeijingChina Beijing Laboratory of Oral Health Capital Medical UniversityBeijingChina

Background The superiority of balloon angioplasty plus aggressive medical management(AMM)to AMM alone for symptomatic intracranial artery stenosis(sICAS)on efficacy and safety profiles still lacks evidence from randomised controlled trials(RCTs).Aim To demonstrate the design of an RCT on balloon angioplasty plus AMM for sICAS.Design Balloon Angioplasty for Symptomatic Intracranial Artery Stenosis(BASIS)trial is a multicentre,prospective,randomised,open-label,blinded end-point trial to investigate whether balloon angioplasty plus AMM could improve clinical outcome compared with AMM alone in patients with sICAS.Patients eligible in BASIS were 35–80 years old,with a recent transient ischaemic attack within the past 90 days or ischaemic stroke between 14 days and 90 days prior to enrolment due to severe atherosclerotic stenosis(70%–99%)of a major intracranial artery.The eligible patients were randomly assigned to receive balloon angioplasty plus AMM or AMM alone at a 1:1 ratio.Both groups will receive identical AMM,including standard dual antiplatelet therapy for 90 days followed by long-term single antiplatelet therapy,intensive risk factor management and life-style modification.All participants will be followed up for 3years.Study outcomes Stroke or death in the next 30 days after enrolment or after balloon angioplasty procedure of the qualifying lesion during follow-up,or any ischaemic stroke or revascularisation from the qualifying artery after 30 days but before 12 months of enrolment,is the primary outcome.Discussion BASIS trail is the first RCT to compare the efficacy and safety of balloon angioplasty plus AMM to AMM alone in sICAS patients,which may provide an alternative perspective for treating sICAS.Trial registration number NCT03703635;https://www.***.gov.

关键词： balloon prospective centre

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From strength to precision: A systematic review exploring the clinical utility of 7-Tesla magnetic resonance imaging in abdominal imaging

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World Journal of Radiology 2024年第1期16卷 20-31页

作者： Arosh S Perera Molligoda Arachchige Ana Claudia Teixeira de Castro Gonçalves Ortega Federica Catapano Letterio S Politi Michael N Hoff Faculty of Medicine Humanitas UniversityPieve Emanuele 20072MilanItaly Department of Biomedical Sciences Humanitas UniversityPieve Emanuele 20072MilanItaly IRCCS Humanitas Research Hospital Rozzano 20089MilanItaly Department of neuroradiology IRCCS Humanitas Research HospitalRozzano 20089MilanItaly Department of Radiology and Biomedical Imaging University of CaliforniaSan FranciscoCA 94143United States

BACKGROUND After approval for clinical use in 2017 early investigations of ultra-high-field abdominal magnetic resonance imaging(MRI)have demonstrated the feasibility as well as diagnostic capabilities of liver,kidney,and prostate MRI at 7-Tesla.However,the elevation of the field strength to 7-Tesla not only brought advantages to abdominal MRI but also presented considerable challenges and drawbacks,primarily stemming from heightened artifacts and limitations in Specific Absorption Rate,etc.Furthermore,evidence in the literature is relatively scarce concerning human studies in comparison to phantom/animal studies which necessitates an investigation into the evidence so far in humans and summarizing all relevant evidence.AIM To offer a comprehensive overview of current literature on clinical abdominal 7T MRI that emphasizes current trends,details relevant challenges,and provides a concise set of potential solutions.METHODS This systematic review adheres to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.A PubMed search,utilizing Medical Subject Headings terms such as"7-Tesla"and organ-specific terms,was conducted for articles published between January 1,1985,and July 25,2023.Eligibility criteria included studies exploring 7T MRI for imaging human abdominal organs,encompassing various study types(in-vivo/ex-vivo,method development,reviews/meta-analyses).Exclusion criteria involved animal studies and those lacking extractable data.Study selection involved initial identification via title/abstract,followed by a full-text review by two researchers,with discrepancies resolved through discussion.Data extraction covered publication details,study design,population,sample size,7T MRI protocol,image characteristics,endpoints,and conclusions.RESULTS The systematic review included a total of 21 studies.The distribution of clinical 7T abdominal imaging studies revealed a predominant focus on the prostate(n=8),followed by the kidney(n=6)and the hepatobiliary system(n=5).Studies on these organs,and

关键词： 7-Tesla magnetic resonance imaging Abdominal Prostate Kidney Renal Pancreas Hepatobiliary Liver Small bowel

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A comparison between acute large vessel occlusion in the posterior circulation and anterior circulation after endovascular treatment:the ANGEL-ACT registry experience

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Stroke & Vascular Neurology 2022年第4期7卷 285-293,I0001-I0004页

作者： Xuan Sun Jingyu Zhang Xu Tong Baixue Jia Dapeng Mo Ning Ma Feng Gao Lian Liu Xiaochuan Huo Ligang Song Yiming Deng Zhongrong Miao Interventional neuroradiology Center Beijing Tiantan HospitalCapital Medical UniversityBeijingChina

Background and purpose Endovascular treatment(EVT)has shown an overwhelming benefit for acute anterior circulation artery occlusion(ACO).Whether it can achieve the same outcomes in posterior circulation artery occlusion(PCO)has not been well explained.We aimed to evaluate the characteristics and prognosis of ACO and PCO after EVT in a nationwide registry.Method The present analysis was based on the prospective ANGEL-ACT Registry in China between November 2017 and March 2019.Demographic data,periprocedural times,recanalisation rate,intracranial haemorrhage(ICH)and 90-day functional outcomes were compared between the ACO and PCO groups.Results A total of 1793 patients were analysed including 397(22.1%)consecutive patients with PCO and 1396(77.9%)patients with ACO treated with EVT.A larger proportion of patients with PCO had intracranial atherosclerotic disease and received extra angioplasty during EVT.Successful recanalisation and 90-day favourable functional outcomes did not differ significantly between the two groups.Patients with PCO showed lower 24-hour ICH and symptomatic ICH rates.There was a trend towards higher mortality rate in the PCO group(22.09%vs 14.44%;adjusted OR 1.286(95%CI 0.820 to 2.017),p=0.2731),especially when the onset to puncture time was over 6 hours(30.77%vs 11.13%;adjusted OR 2.673(95%CI 1.280 to 5.583),p=0.0089,interactive p=0.0002).Conclusions In this large prospective multicentre registry,there was a significant difference in the characteristics and periprocedural features between patients with PCO and ACO.However,successful recanalisation and 90-day favourable functional outcomes in PCO were equivalent to those in ACO.

关键词： occlusion acute treatment

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