BackgroundIntracranial arterial stenosis is a major cause of ischemic stroke in Asian populations. High-resolution magnetic resonance imaging (HR-MRI) of the vessel wall is an emerging tool that offers valuable insights.MethodsWe conducted a retrospective study of adult patients (≥18 years) with acute ischemic stroke and M1 MCA stenosis who underwent HR-MRI at the University Medical Center Ho Chi Minh City between January 2019 and May 2025.ResultsSixty-two patients were included (mean age, 56 ± 13 years; male-to-female ratio, 2:1). The average stenosis degree was 66.3 ± 17.5, with severe stenosis in 38.7% of patients. The predominant pattern was eccentric stenosis (80.6%), more frequently observed in older patients. The mean remodeling index was 0.87 ± 0.21, and most cases showed negative remodeling. The majority of lesions at the stenotic site exhibited post-contrast enhancement, most commonly grade 2 enhancement (43.6%). The most frequent cause of stenosis was atherosclerosis (43 cases), followed by dissection (2 cases), Moyamoya disease (1 case), and indeterminate etiology (16 cases). Among infarct-associated atherosclerotic lesions, plaques with intraplaque hemorrhage (58.1%), irregular plaque surface (86.1%), and strong (grade 3) enhancement (46.5%) were observed more frequently than in the small non-infarct-associated incidental group; however, this exploratory comparison was limited by the very small size of the comparator group.ConclusionsHR-MRI of the MCA vessel wall provides detailed information on stenotic lesion characteristics, aiding in the identification of the underlying etiology. These findings highlight the potential role of HR-MRI in stroke diagnosis and risk stratification in Vietnamese patients.
Neuroanatomy remains one of the most challenging areas in medical education, including neuroradiology, due to its complexity and limitations of traditional teaching methods. This study proposes a novel approach based on systematic image and video sequences to enhance the presentation, exploration, communication, learning, and teaching of neuroanatomy. Systematic image sequences are ordered sets of spatially and contextually correlated images characterized by five features: anatomical content, parcellation, annotation, location, and dimensionality. Five elementary sequence types are introduced: appearance, contextual, multi-dimensional, dissection, and special, which can be combined into composite (homogeneous/heterogeneous, uni-view/multi-view) sequences. These sequences are presented in interactive, single multi-image, and automated modes, and extended to video formats. The sequences were created using a high-resolution, fully parcellated 3D atlas of the human brain, head, and neck. 12 image sequences (51 images) and two video sequences are presented and discussed, along with references to three major resources of ready-to-use sequences: NOWinBRAIN repository (over 8600 3D neuroimages), ebook Neuroanatomy Made Easy (over 350 sequences), and the latest edition of Gray's Anatomy/Chapter_28. The proposed sequences enhance visualization and understanding of anatomical structures and relationships. Appearance sequences improve recognition through parcellation and labeling, while contextual sequences reveal spatial relationships. Dissection and cortical opening sequences expose otherwise hidden structures, and multi-dimensional sequences bridge 2D radiology with 3D anatomy. Hence, the method elucidates complex anatomical organization, including cortico-vascular relationships, ventricular-venous alignment, and cranial nerve pathways. Overall, systematic image-video sequences provide a conceptually straightforward, easy-to-use, simply integrable, and cost-effective framework enhancing spatial understanding and interpretation, particularly in neuroradiology.
Magnetic Resonance Elastography (MRE) noninvasively maps brain biomechanics and is highly sensitive to alterations associated with aging and neurodegenerative disease. Most implementations use a single frequency or a narrow frequency band, limiting the analysis of frequency-dependent viscoelasticity parameters. We developed a dual-actuator wideband MRE (5-50 Hz) protocol and acquired wave fields at 13 frequencies in 24 healthy adults (young: 23-39 years; older: 50-63 years). Shear wave speed (SWS) maps were generated as a proxy for stiffness, and SWS dispersion was modeled using Newtonian, Kelvin-Voigt, and power-law rheological models. Whole-brain stiffness declined with age, with the strongest effect observed at low frequencies (5-16 Hz: -0.24%/year; p = 0.038) compared with mid (20-35 Hz: -0.12%/year; p = 0.040) and high frequencies (40-50 Hz: -0.10%/year; p = 0.123). Compared to older brains, younger adults showed 8.96% higher baseline stiffness in the power-law model (p = 0.013) and 8.15-8.39% higher viscosity according to the Newtonian and Kelvin-Voigt model (p < 0.05). White and cortical gray matter exhibited similar age-related decreases, while deep gray matter showed an increase in the power-law exponent (+0.001/year; p = 0.046), suggesting a transition toward more fluid-like properties associated with aging. Wideband MRE revealed frequency-dependent and region-specific biomechanical alterations with aging, with the strongest effects observed at low frequencies. Extending brain MRE into the low frequency regime potentially enhances sensitivity to solid-fluid interactions. Therefore, low frequency MRE may serve as an early biomechanical marker of microstructural brain changes due to aging and neurodegeneration. STATEMENT OF SIGNIFICANCE: Magnetic Resonance Elastography (MRE) is a noninvasive imaging modality that quantifies the mechanical properties of brain tissue. Conventional approaches are typically restricted to single or narrow vibration frequency ranges, limiting their ability to characterize frequency-dependent viscoelastic behavior. In this study, we establish a wideband MRE framework spanning 5-50 Hz and apply it in vivo to healthy adults across different age groups. Our results demonstrate that age-related brain softening is most pronounced at low frequencies, indicating sensitivity to microstructural alterations and potentially enhancing sensitivity to fluid-solid interactions. These findings highlight diagnostic potential of low frequency MRE for advancing biomechanical biomarkers of brain aging and for future applications in early detection of neurodegenerative disease.
Background and Purpose: Subarachnoid hemorrhage is commonly associated with a venous stroke. In infants with a chronic subdural hemorrhage a laminar SAH is produced by blood leakage from thrombosed cortical veins into a potential subarachnoid space previously unrecognized. This paper discusses how to distinguish a laminar SAH from a subdural hemorrhage. Methods: A retrospective review of 34 selected cases of infant venous stroke in the period 2014-2025 is based on neuroimaging studies. The cases selected are from unsolicited referrals from parents, attorneys, and physicians where caregivers are accused of abusive head trauma. Results: The median age is 3 months old. All 34 infants exhibit a venous stroke defined as the presence of a blood clot(s) in a venous sinus or cortical vein or SAH from a leaking thrombosed cortical vein. 33/34 cases feature an associated chronic subdural hemorrhage/hygroma. Thrombosed veins are located subjacent to the arachnoid membrane. 28/34 cases show multifocal (<2cm diameter) SAHs. 24/34 cases show laminar SAHs (>2cm diameter); 10/24 thin (<3mm) and 14/24 thick (>3mm). Intrasulcal SAH is infrequent. Conclusion: The laminar SAH is a non-gyral SAH distinguished from a subdural hemorrhage by its location and rapid resolution. Its combination with the adjacent chronic subdural hemorrhage is commonly and incorrectly described as a mixed density or layered subdural hemorrhage. The laminar SAH is hypothetically located between the arachnoid membrane and a trabecular coat investing the cortical veins. Alternately, it may suggest existence of a 4th meningeal layer recently discovered by anatomists in animal models.
IntroductionThe deep cerebral venous system plays a critical role in surgical approaches to the pineal and posterior third ventricular regions-areas that are particularly challenging in pediatric neurosurgery. While adult venous anatomy is well described, data on normal pediatric venous development remain scarce. Surgical planning in children often relies on extrapolating adult anatomy, which may not reflect age-related anatomical variations that occur during rapid brain growth.MethodsWe retrospectively analyzed high-resolution 3.0 T contrast-enhanced MRIs from 85 pediatric patients (aged 15 days-17 years) performed at a single tertiary center. Key venous angles (ICV-GV, GV-SS, SS-SSS, BV-GV) and distances (BV-BV, ICV-ICV, ICV-BV) were measured using multiplanar reconstruction. Correlations with age were assessed using Pearson correlation and linear regression. Patients were divided into three age groups (0-3 years, 4-12 years, 13-18 years), and group differences were evaluated with ANOVA and Bonferroni correction.ResultsSignificant age-related variations were identified in the conformation of the deep venous system. The ICV-GV, GV-SS, and SS-SSS angles widened with age (p < .001), while BV-GV angles decreased. BV-BV distance increased progressively from infancy to adolescence (p < .001). The ICV-BV relationship remained stable across age groups. Group comparisons confirmed significant differences between the youngest (0-3 years) and oldest (13-18 years) cohorts for most parameters.ConclusionThe venous anatomy of the pineal region evolves significantly with age. Understanding these changes can optimize preoperative planning and surgical strategies in pediatric patients. These data provide age-specific anatomical references that may support neurosurgeons worldwide, including those working in low-resource settings without routine access to neuronavigation.
Background and purposeInterpretation of imaging findings after radiation can be challenging in patients with high-grade glioma. Appearance of contrast-enhancing lesions during follow-up imaging poses difficulty in differentiating true progression from treatment-related changes. In the current study, we report patterns and clinical outcomes of radiation-induced subependymal enhancement.Materials and methodsPatients with histopathological diagnosis of HGG developing radiation-induced contrast enhancement in the subependymal region were considered in the retrospective study. The subependymal enhancement was required to be in the high-dose region of radiotherapy. Patients underwent multiparametric magnetic resonance imaging (MRI), which included T1-contrast, T2-weighted, perfusion, and spectroscopy. Confirmation of radiation changes rather than disease progression was decided based on regression or stability of concerned findings on follow-up imaging.ResultsThirty-four patients were included in the analysis. The median time from radiotherapy to onset of subependymal enhancement was 15 months. The enhancement pattern was feathery, nodular, and linear in 53%, 35%, and 3% of patients, respectively. A T2-hyperintense signal with a hypointense rim was seen in 74% of patients. Majority of these lesions were isoperfused (26%) or hypoperfused (47%). The median radiological follow-up after onset of subependymal enhancement was 7 months (range 1-61 months). At final follow-up, complete resolution, partial regression, and stable findings of the concerned enhancement were seen in 18%, 38%, and 44%, respectively.ConclusionSubependymal enhancement can be seen following radiation, which should be considered during the evaluation of follow-up imaging. Multiparametric MRI with specific contrast patterns, T2-weighted findings, and perfusion imaging can help identify radiation-induced enhancement.
PurposeOnly limited studies have directly compared apparent diffusion coefficient (ADC) values at term-equivalent age (TEA) between normal term infants and very preterm infants. We hypothesized that regional ADC values at TEA would differ between preterm infants and term infants, even in the absence of MRI-detectable brain injury. The purpose of this study was to compare ADC values at TEA between term infants and preterm infants born at less than 32 weeks of gestation.Subjects and methodsThis retrospective study enrolled consecutive infants who underwent neonatal brain MRI over a 7-year period from 2016 to 2022. From this cohort, very preterm infants were selected after confirmation of normal MRI findings and normal neurodevelopmental outcomes. ADC values were measured at six predefined brain regions. ADC values were compared between term infants and preterm infants, and further subgroup analyses were performed among term, very preterm, and extremely preterm infants.ResultsADC values at the basal ganglia were significantly higher in preterm infants compared with term infants. No significant differences were observed at the other five brain regions. Subgroup analysis among term, very preterm, and extremely preterm infants demonstrated significant differences in basal ganglia ADC values, with both very preterm and extremely preterm infants showing higher ADC values than term infants.ConclusionADC values at the basal ganglia at TEA were significantly higher in preterm infants than in term infants, despite normal conventional MRI findings and favorable neurodevelopmental outcomes. These findings suggest region-specific differences in brain microstructural maturation associated with preterm birth.
BackgroundIschemic stroke, often caused by intracranial atherosclerotic stenosis (ICAS), is a leading cause of disability and death globally. 7T MRI offers improved signal-to-noise ratio (SNR) and contrast, enhancing MRA image quality. This study assessed the accuracy of 7T high-resolution (HR) MRI and time-of-flight MRA (TOF-MRA) in measuring middle cerebral artery (MCA) stenosis compared to digital subtraction angiography (DSA).MethodsIn this prospective observational study, patients, diagnosed with MCA atherosclerotic stenosis, underwent 7T HR-MRI, TOF-MRA and DSA. Spearman correlation analysis was used to assess the linear correlation between HR-MRI, TOF-MRA, and DSA measurements of MCA stenosis. Agreement for stenosis classification data was evaluated using weighted kappa values. Receiver Operating Characteristic (ROC) curves were utilized to predict severe stenosis and occlusion of MCA in HR-MRI and TOF-MRA.ResultsThis study included 86 lesions from 81 patients with MCA atherosclerotic stenosis. The stenosis degree measurements between 7T HR-MRI and DSA indicated a very strong correlation (r = 0.8000; p < .0001). The correlation between 7T TOF-MRA and DSA assessments was high (r = 0.7188; p < .001). A robust correlation between 7T HR-MRI and TOF-MRA evaluations was shown (r = 0.839; p < .0001). 7T TOF-MRA (K = 0.673) demonstrated substantial agreement with DSA measurements, showing slight superiority over HR-MRI (K = 0.589). ROC analysis indicated both 7T HR-MRI and TOF-MRA effectively predicted severe MCA stenosis and occlusion (HR-MRI, AUC: 0.888; TOF-MRA, AUC: 0.878).Conclusions7T HR-MRI and TOF-MRA may emerge as comparable modalities for assessing MCA atherosclerotic stenosis, and HR-MRI allows for precise evaluation through direct visualization of the vessel lumen and plaque.
BackgroundThis study aims to assess whether T2 relaxometry can distinguish tissue characteristics between high-grade gliomas and non-infiltrative lesions.MethodsWe report our initial experience using the Relaxo LNI software to analyze multi-echo T2 relaxometry magnetic resonance imaging in patients with high-grade gliomas. For comparison, peritumoral T2-hyperintense areas in meningiomas and metastases were used as reference regions for vasogenic edema, based on the established concept that these tumor types typically do not infiltrate adjacent tissue. In contrast, peritumoral hyperintensity observed in high-grade gliomas may represent either vasogenic edema or tumor infiltration.ResultsData from 30 patients were analyzed, including 20 with high-grade gliomas and 10 with metastasis or meningiomas. A statistically significant difference was observed in multi-echo T2 relaxation values between the glioma and non-glioma groups (p < 0.05). Mean T2 relaxation times were longer in the high-grade glioma group than in the non-glioma group (p < 0.05). Within the high-grade glioma group, central regions showed significantly longer mean relaxation times than peripheral regions (p < 0.05).ConclusionOur preliminary findings suggest that T2 relaxometry identifies differences in relaxation profiles between tumor tissue and control edema, indicating potential value in detecting variations in peritumoral tissue composition in high-grade gliomas. However, these results are exploratory and hypothesis-generating, lack histopathological validation, and require further investigation to clarify the role of T2 mapping in preoperative planning.
Arteriovenous fistulas (AVFs) involving the inferior petroclival vein (IPCV) are extremely rare and may mimic cavernous sinus (CS) dural arteriovenous fistulas (DAVF) because of shared venous drainage patterns. A 72-year-old man presented with diplopia and left ocular chemosis. Carotid angiography revealed retrograde venous drainage into the superior ophthalmic vein via the inferior petrosal sinus (IPS) and CS. The initial findings suggested a CS-DAVF; however, three-dimensional angiography, including multiplanar reconstruction and maximum intensity projection analyses, identified shunt pouches in the IPCV and anterior condylar vein. Transvenous embolization via the IPS allowed the selective coil embolization of the IPCV shunt pouch while preserving the IPS. The IPCV-AVF resolved completely. Although the anterior condylar vein dural AVF remained, it was classified as Borden type I and was managed conservatively. The present case highlights the importance of detailed three-dimensional angiographic analysis to distinguish IPCV-AVF from CS-DAVF and guide effective treatment.
BackgroundThe aortic arch (AA) influences catheter navigation during endovascular treatment (EVT) for acute ischemic stroke. Whether routine inclusion of the AA in stroke CT angiography (CTA) protocols is necessary remains debated, particularly in settings aiming to streamline imaging workflows.PurposeTo evaluate whether machine learning algorithms (MLAs) can use routinely available clinical and laboratory data to estimate AA configuration in patients with stroke risk factors.Materials and MethodsIn this retrospective study, 108 patients who underwent CTA, including the AA, were analyzed. Eight MLAs were trained to classify AA anatomy as favorable or unfavorable using clinical and laboratory variables available at presentation. Class imbalance was addressed using the Synthetic Minority Oversampling Technique. Model performance was evaluated using five-fold cross-validation and summarized with seven performance metrics.ResultsAfter class balancing, mean accuracy across classifiers ranged from 0.52 to 0.77. Gaussian copula and Naive Bayes classifiers showed the highest accuracy, while k-nearest neighbors and support vector machines demonstrated higher sensitivity. Specificity was highest for regularized discriminant analysis and the Gaussian copula. AUROC values ranged from 0.49 to 0.80 across models.ConclusionRoutinely available clinical and laboratory data contain a limited yet detectable signal, enabling several machine learning algorithms to estimate AA configuration with moderate accuracy. These findings are exploratory and do not support modification of CTA protocols. However, they suggest that pre-imaging clinical data may provide supportive information for future workflow-oriented decision-support tools. Further validation in larger, externally tested cohorts is required before clinical integration can be considered.
BackgroundThe susceptibility vessel sign (SVS) on MRI has been linked to functional outcomes and reperfusion success after endovascular treatment (EVT), suggesting its potential as a prognostic marker. This updated systematic review and meta-analysis aimed to evaluate the prognostic and etiological significance of SVS in acute ischemic stroke (AIS).MethodsWe conducted a systematic search of PubMed, Embase, and Cochrane in May 2025. Eligible studies included post-hoc analyses of randomized controlled trials (RCTs) and observational studies of AIS patients treated with EVT and/or intravenous thrombolysis (IVT). Pooled risk ratios (RRs) with 95% confidence intervals (CIs) were calculated using a random-effects model. Primary outcome was successful reperfusion (mTICI 2b-3). Secondary outcomes included functional independence (modified Rankin Scale [mRS] score 0-2), mortality, stroke etiology, and time metrics.ResultsEighteen studies (n = 2602) were included. Overall, SVS was not associated with higher reperfusion rates (12 studies; n = 2083; RR: 1.01; 95% CI: 0.93-1.10; p = .832; I2 = 56.0%), except in the SWI subgroup (2 studies; RR: 1.17; 95% CI: 1.02-1.34; p = .022; I2 = 0.0%). SVS+ was linked to lower 90-day mortality in anterior circulation strokes (3 studies; n = 865; RR: 0.52; 95% CI: 0.36-0.74; p < .001; I2 = 0%), improved 90-day functional independence in Western populations (7 studies; n = 1481; RR: 1.22; 95% CI: 1.01-1.47, p = .039; I2 = 37.7%), and in cardioembolic stroke etiology using GRE (9 studies; n = 1058; RR: 1.29; 95% CI: 1.05-1.57; p = .014; I2 = 36.3%). The mean time from onset to treatment was 238.19 minutes ± 147.5.ConclusionsAlthough SVS+ did not predict reperfusion, it was associated with better functional outcomes in Western populations, particularly in cardioembolic stroke, and lower mortality, thereby reinforcing its prognostic value. MRI protocols did not delay treatment, but high heterogeneity limits certainty, highlighting the need for prospective studies.
PurposeTo characterize demographic variation in quantitative MR neurography parameters of the peroneal nerve and to assess the methodological impact of epineurium inclusion on signal intensity-based measurements.Materials and MethodsThis retrospective single-center study included 114 screened, presumably healthy subjects undergoing routine 3-T knee MRI. Cross-sectional area (CSA), signal intensity (SI), and nerve-to-muscle SI ratios of the peroneal nerve were measured at three predefined levels, with and without epineurium inclusion. Associations with age, body mass index (BMI), and sex were evaluated using univariable linear regression. Agreement between SI measurements with and without epineurium was assessed using cubic spline regression. Exploratory fuzzy c-means clustering was applied to visualize demographic trends.ResultsSI ratios measured with and without epineurium showed excellent agreement without evidence of a clinically relevant systematic bias. Increasing age was significantly associated with larger CSA (p < .05). In contrast, SI ratios showed no significant age-related association and only weak trends. BMI demonstrated no significant association with either CSA or SI, and no relevant sex-related differences were observed. Fuzzy clustering corroborated regression findings, demonstrating gradual demographic trends with substantial overlap between clusters.ConclusionQuantitative MR neurography parameters of the peroneal nerve exhibit small, gradual variations with age and body mass index, primarily affecting cross-sectional area, while signal-intensity ratios remain largely stable. Measurements with and without epineurium inclusion show strong agreement, indicating that demographic-related variability is modest and should be interpreted as physiological variation rather than pathological change.
Dural venous sinus injury (DVSI) can occur after traumatic brain injury and lead to impaired cerebral venous outflow through extrinsic compression, intraluminal thrombosis, or mixed mechanisms. It can progress to a sinus tear or transection with hemorrhage. On noncontrast-enhanced head CT, DVSI may be subtle and can be confounded by adjacent fractures, extra-axial blood products, and filling defects such as arachnoid granulations. Although the reported incidence of severe head injury is 1-4%, modern trauma imaging has revealed a substantially higher burden of DVSI and dural venous sinus thrombosis (DVST) in patients with skull base and calvarial fractures, particularly when fractures cross or overlie major sinuses or the jugular bulb. This narrative review focuses on acute post-traumatic dural venous sinus injury and synthesizes current knowledge on the angiographic anatomy. We also highlight the strengths and limitations of CT venography (CTV), MR venography (MRV), and adjunctive digital subtraction angiography in detecting DVSI, differentiating intraluminal thrombus from extrinsic compression, and characterizing collateral pathways. Finally, we review management strategies, including neurosurgical decompression for mechanically compressed sinuses, the non-standardized use of systemic anticoagulation for DVST in the presence of a hemorrhage, and the role of detailed venographic mapping for operative planning. Timely recognition of these injuries and their complications, guided by a systematic venographic approach, is essential for mechanism-based management that may reduce the risk of serious sequelae including venous infarction.
Aicardi-Goutières syndrome (AGS) and genes-related interferonopathies are a group of multisystem disorders involving the central nervous system, caused by pathogenic variants in genes regulating nucleic acid metabolism and type I interferon signaling, leading to chronic interferon overproduction. This retrospective multicenter study analyzed the efficacy and safety of Janus kinase 1/2 (JAK1/2) inhibitors in 12 patients treated with Baricitinib or Ruxolitinib, compared with 20 untreated patients. Treatment showed improvement in immunological and dermatological symptoms, while the impact on neurological manifestations was limited and heterogeneous, with greater benefits in patients with mild or intermediate phenotypes and earlier treatment initiation. Neuroroimaging analyses in untreated patients showed radiological improvements equal to or greater than those treated, raising doubts about the true impact of JAK 1/2 inhibitors on the neuroradiological course. Adverse events were rare and mild, confirming the favorable safety profile of this treatment. The results suggest that the pathogenetic complexity of AGS goes beyond the JAK-STAT pathway, highlighting the need for larger prospective studies to identify subgroups most likely to benefit from this therapeutic approach and to refine treatment strategies.
BackgroundCarotid artery calcification represents a common feature of atherosclerotic plaques. However, the geometric relationships of calcific clusters have not been systematically investigated. This study aimed to develop a geometry-based atlas, independent of symptom status, characterizing the three-dimensional properties of calcium clusters within carotid plaques and quantifying population-level distributions and data-driven couplings between size, shape, and density.MethodsStandardized three-dimensional calcium masks of clinical CT scans were analyzed using connected-component labeling. Extracted features included cluster volume, aspect ratio, eccentricity, compactness, and CT attenuation values (mean μ, standard deviation σ). Associations between cluster features were assessed using Spearman correlations with Benjamini-Hochberg false discovery rate correction. Independent associations were determined using partial Spearman correlation and restricted cubic spline regression.ResultsAmong 107 plaques, 149 distinct clusters were identified, most frequently presenting as a single elongated cluster (aspect ratio = 2.23). Independent associations (all p < 0.001) were identified for: eccentricity with μ (ρ = -0.39), volume with μ (ρ = 0.47), compactness with μ (ρ = 0.39), and volume with eccentricity (ρ = 0.82). Multi-cluster plaques exhibited smaller mean cluster volume (76.1 vs 359.5 mm3; p < 0.001) and lower eccentricity (0.5 vs 1.6; p < 0.001) compared with single-cluster plaques.ConclusionCarotid calcification most frequently manifests as a single elongated cluster, with robust couplings between cluster size, shape, and density. These geometric archetypes provide a quantifiable framework for future biomechanical and biological studies of plaque vulnerability.
Parkinson's disease (PD) is a chronic progressive neurodegenerative disorder characterized by tremors, rigidity, and bradykinesia. This is primarily attributed to loss of nigrostriatal dopaminergic neurons to varying degrees. Many conditions that present similar classic motor symptoms of PD, known as atypical parkinsonian syndromes (APS), have also been identified. These encompass multiple system atrophy (MSA), progressive supranuclear palsy (PSP), dementia with Lewy bodies (DLB), and corticobasal degeneration (CBD). On the other hand, causes of non-neurodegenerative parkinsonism include vascular parkinsonism, drug-induced parkinsonism, and essential tremors. Neuroimaging plays a significant role in discriminating PD from its mimics which may represent a significant challenge in clinical practice. This article aims to review recent developments in imaging technologies, particularly magnetic resonance imaging (MRI) and nuclear medicine imaging techniques, that have the potential to unravel characteristic morphological and metabolic changes in the brain and would aid in the early diagnosis of PD and its differentiation from its potential mimickers.Learning objectivesTo identify the peculiar structural imaging features of atypical parkinsonian syndromes and recognize the role of the current state-of-the-art neuroimaging modalities (particularly MRI and nuclear medicine techniques) in discriminating Parkinson's disease from its mimics.
Background and objectivesBasilar artery occlusion accounts for a small fraction of ischemic strokes but carries a disproportionally poor natural history, with high rates of death and disability under best medical therapy (BMT). Endovascular treatment is used to treat these patients, though evidence of its safety and efficacy in different time windows compared to BMT remains conflicted. To address this, this Bayesian meta-analysis evaluates the outcomes of endovascular treatment for basilar artery occlusion performed in early (0-6 h) and late (>6 h) windows versus BMT.Materials and methodsFollowing PRISMA guidelines, databases were searched through for studies comparing endovascular versus BMT in patients with basilar artery occlusion. Randomized controlled trials, prospective, and retrospective studies reporting at least one clinical outcome were included. A Bayesian random-effects network meta-analysis was performed to compare endovascular treatment within 0-6 h and beyond 6 h with BMT.ResultsSeven studies comprising 4,125 patients were included. EVT demonstrated superior functional outcomes compared to BMT across both time windows, with the late (>6 h) window showing a higher probability of achieving favorable modified Rankin Scale (mRS) scores (0-2). Mortality reduction was not consistent, and both early and late EVT were associated with higher risks of hemorrhagic and overall complications. Despite these safety concerns, the overall benefit-to-risk balance favored EVT as the preferred therapy for BAO.ConclusionThe findings underscore the importance of imaging-based selection and individualized decision-making, suggesting that EVT beyond traditional time windows remains effective when guided by appropriate clinical and radiological criteria.
IntroductionPreoperative embolization reduces intraoperative blood loss (IBL) in meningioma treatment, but the optimal embolic material remains uncertain. This systematic review and meta-analysis compares the effectiveness and safety of particle versus liquid embolic agents in the preoperative embolization of meningiomas.MethodsPubMed, Cochrane, Embase, and Scopus were searched for studies comparing particles and liquid embolic agents in patients undergoing preoperative embolization of meningiomas. Primary outcomes included the degree of devascularization, IBL, ischemic events, and overall complications. The risk of bias was assessed using the ROBINS-I. Statistical analyses were conducted using R.ResultsThe analysis included four studies, covering a total of 1827 patients. Particles were associated with a significantly lower incidence of operative complications (OR = 0.35; 95% CI 0.20-0.62; p < 0.001; I2 = 0.0%). The other outcomes did not differ between groups. Regarding IBL, no significant difference was observed between particulate and liquid embolic agents (MD = -65.01 mL; 95% CI -237.01-107.00; p = 0.46; I2 = 77.8%).ConclusionOur systematic review and meta-analysis indicate no significant differences between particulate and embolic agents; however, particulate agents were associated with a lower incidence of overall complications, suggesting a potential advantage in perioperative safety.