Intraluminal Flow Diverter Design Primer for Neurointerventionalists

神经介入医师的血流导向装置设计入门

The clinical use of flow diverters for the treatment of intracranial aneurysms has rapidly grown. Consequently, the market and technology for these devices has also grown. Clinical performance characteristics of the flow diverter are well-known to the clinician. However, the engineering design principles behind how these devices achieve ideal clinical performance are less understood. This primer will summarize flow diverter design parameters for neurointerventionalists with the aim of promoting collaboration between clinicians and engineers.

用于治疗颅内动脉瘤的分流器的临床使用已迅速增长。因此，这些设备的市场和技术也在增长。血流导向装置的临床表现特征是临床医生所熟知的。然而，这些设备如何实现理想的临床性能背后的工程设计原理却知之甚少。本入门书将总结神经介入医生的血流导向装置设计参数，以促进临床医生和工程师之间的合作。

REF: Oliver AA, Senol YC, Bilgin C, et al. Intraluminal Flow Diverter Design Primer for Neurointerventionalists. AJNR Am J Neuroradiol. 2024;45(4):365-370. Published 2024 Apr 8. doi:10.3174/ajnr.A8076 PMID: 38164542

Understanding Bias in Artificial Intelligence: A Practice Perspective

理解人工智能中的偏见: 实践视角

In the fall of 2021, several experts in this space delivered a Webinar hosted by the American Society of Neuroradiology (ASNR) Diversity and Inclusion Committee, focused on expanding the understanding of bias in artificial intelligence, with a health equity lens, and provided key concepts for neuroradiologists to approach the evaluation of these tools. In this perspective, we distill key parts of this discussion, including understanding why this topic is important to neuroradiologists and lending insight on how neuroradiologists can develop a framework to assess health equity-related bias in artificial intelligence tools. In addition, we provide examples of clinical workflow implementation of these tools so that we can begin to see how artificial intelligence tools will impact discourse on equitable radiologic care. As continuous learners, we must be engaged in new and rapidly evolving technologies that emerge in our field. The Diversity and Inclusion Committee of the ASNR has addressed this subject matter through its programming content revolving around health equity in neuroradiologic advances.

在2021年秋天，该领域的几位专家发表了由美国神经放射学会 (ASNR) 多样性和包容性委员会主办的网络研讨会，重点是通过健康公平的视角扩大对人工智能偏见的理解，并为神经放射科医生提供了关键概念，以评估这些工具。从这个角度来看，我们提炼了这个讨论的关键部分，包括理解为什么这个话题对神经放射学家很重要，以及提供关于神经放射学家如何开发一个框架来评估人工智能工具中与健康公平相关的偏见的见解。此外，我们提供了这些工具的临床工作流程实施的示例，以便我们可以开始看到人工智能工具将如何影响公平放射学护理的讨论。作为持续的学习者，我们必须参与我们领域中出现的新的和快速发展的技术。ASNR的多样性和包容性委员会通过围绕神经放射学进展中的健康公平的编程内容解决了这一主题。

REF: Davis MA, Wu O, Ikuta I, Jordan JE, Johnson MH, Quigley E. Understanding Bias in Artificial Intelligence: A Practice Perspective. AJNR Am J Neuroradiol. 2024;45(4):371-373. Published 2024 Apr 8. doi:10.3174/ajnr.A8070 PMID: 38123951

Shift Volume Directly Impacts Neuroradiology Error Rate at a Large Academic Medical Center: The Case for Volume Limits

移位量直接影响大型学术医学中心的神经放射学错误率: 体积限制的情况

Unlike in Europe and Japan, guidelines or recommendations from specialized radiological societies on workflow management and adaptive intervention to reduce error rates are currently lacking in the United States. This study of neuroradiologic reads at a large US academic medical center, which may hopefully contribute to this discussion, found a direct relationship between error rate and shift volume. Lower shift volumes yielded significantly lower error rates. The lowest error rates were observed with shift volumes that were limited to 19-26 studies. Error rates at shift volumes between 67-90 studies were 226% higher, compared with the error rate at shift volumes of ≤ 19 studies.

与欧洲和日本不同，美国目前缺乏专业放射学会关于工作流管理和适应性干预以降低错误率的指南或建议。这项在美国大型学术医学中心进行的神经放射学读数研究，有望有助于这一讨论，发现错误率与移位量之间存在直接关系。较低的移位量产生显著较低的错误率。用限于19-26项研究的移位体积观察到最低的错误率。与 ≤ 19项研究的轮班量错误率相比，67-90项研究的轮班量错误率226% 更高。

REF: Ivanovic V, Broadhead K, Chang YM, et al. Shift Volume Directly Impacts Neuroradiology Error Rate at a Large Academic Medical Center: The Case for Volume Limits. AJNR Am J Neuroradiol. 2024;45(4):374-378. Published 2024 Apr 8. doi:10.3174/ajnr.A8119 PMID: 38238099

Clinical Evaluation of a 2-Minute Ultrafast Brain MR Protocol for Evaluation of Acute Pathology in the Emergency and Inpatient Settings

用于评估急诊和住院患者急性病理的2分钟超快脑MR方案的临床评估

Ultrafast MR imaging (2.1 minutes) reconstructed with machine-learning assisted framework demonstrated significant reduction in motion artifacts and 98.5% agreement with the reference MR protocol (10 minutes) on the main clinical diagnosis, though there were greater image noise and geometric distortion on the ultrafast protocol.

使用机器学习辅助框架重建的超快MR成像 (2.1分钟) 显示出运动伪影的显着减少，并且在主要临床诊断上与参考MR协议 (10分钟) 98.5% 一致，尽管存在更大的图像噪声和几何失真超快协议。

REF: Lang M, Clifford B, Lo WC, et al. Clinical Evaluation of a 2-Minute Ultrafast Brain MR Protocol for Evaluation of Acute Pathology in the Emergency and Inpatient Settings. AJNR Am J Neuroradiol. 2024;45(4):379-385. Published 2024 Apr 8. doi:10.3174/ajnr.A8143 PMID: 38453413

Increased Intracranial Arterial Pulsatility and Microvascular Brain Damage in Pseudoxanthoma Elasticum

弹性假黄瘤的颅内动脉搏动和微血管脑损伤增加

Carotid siphon calcification might contribute to the high prevalence of cerebrovascular disease in pseudoxanthoma elasticum through increased arterial flow pulsatility. This study aimed to compare intracranial artery flow pulsatility, brain volumes, and small-vessel disease markers between patients with pseudoxanthoma elasticum and controls and the association between arterial calcification and pulsatility in pseudoxanthoma elasticum. Patients with pseudoxanthoma elasticum have increased intracranial artery flow pulsatility and measures of small-vessel disease. Carotid siphon calcification might underlie the high prevalence of cerebrovascular disease in pseudoxanthoma elasticum.

颈动脉虹吸钙化可能通过增加动脉血流搏动而导致弹性假黄瘤中脑血管疾病的高患病率。这项研究旨在比较弹性假黄瘤患者和对照组之间的颅内动脉血流搏动性，脑容量和小血管疾病标志物，以及弹性假黄瘤中动脉钙化和搏动性之间的关联。弹性假黄瘤患者的颅内动脉血流搏动性增加，小血管疾病的措施。颈动脉虹吸钙化可能是弹性假黄瘤中脑血管疾病高发的基础。

REF: Bartstra JW, van den Beukel T, Kranenburg G, et al. Increased Intracranial Arterial Pulsatility and Microvascular Brain Damage in Pseudoxanthoma Elasticum. AJNR Am J Neuroradiol. 2024;45(4):386-392. Published 2024 Apr 8. doi:10.3174/ajnr.A8212 PMID: 38548304

Hemorrhage Volume Drives Early Brain Injury and Outcome in Poor-Grade Aneurysmal SAH

低分级动脉瘤性SAH的早期脑损伤和预后

Early brain injury (radiologically defined by global cerebral edema) is a major determinant of clinical outcome in poor-grade aneurysmal SAH. In this retrospective study of 400 patients with poor-grade aneurysmal SAH, it was shown that intracerebral hemorrhage volume independently predicted global cerebral edema and long-term outcome, intraventricular hemorrhage volume predicted mortality and long-term outcome, and SAH volume predicted long-term clinical outcome.

早期脑损伤 (放射学定义为全局性脑水肿) 是低分级动脉瘤性SAH临床预后的主要决定因素。在这项对400例低分级动脉瘤性SAH患者的回顾性研究中，结果表明，脑出血体积独立预测整体脑水肿和长期结果，脑室内出血体积预测死亡率和长期结果，SAH体积预测长期临床结果。

REF: Panni P, Simionato F, Cao R, et al. Hemorrhage Volume Drives Early Brain Injury and Outcome in Poor-Grade Aneurysmal SAH. AJNR Am J Neuroradiol. 2024;45(4):393-399. Published 2024 Apr 8. doi:10.3174/ajnr.A8135 PMID: 38453415

The Management of Persistent Distal Occlusions after Mechanical Thrombectomy and Thrombolysis: An Inter- and Intrarater Agreement Study

机械取栓和溶栓后持续性远端闭塞的管理: 一项内部和内部协议研究

The best management of patients with persistent distal occlusion after mechanical thrombectomy with or without IV thrombolysis remains unknown. We sought to evaluate the variability and agreement in decision-making for persistent distal occlusions. Individuals did not agree regarding the best management of patients with persistent distal occlusion after mechanical thrombectomy and IV thrombolysis. There is sufficient uncertainty to justify a dedicated randomized trial.

机械取栓后有或没有静脉溶栓的持续性远端闭塞患者的最佳治疗方法尚不清楚。我们试图评估持续性远端闭塞决策的可变性和一致性。对于机械取栓和静脉溶栓后持续性远端闭塞患者的最佳治疗，个人不同意。有足够的不确定性来证明专门的随机试验是合理的。

REF: Boisseau W, Benomar A, Ducroux C, et al. The Management of Persistent Distal Occlusions after Mechanical Thrombectomy and Thrombolysis: An Inter- and Intrarater Agreement Study. AJNR Am J Neuroradiol. Published online February 22, 2024. doi:10.3174/ajnr.A8149 PMID: 38388684

A Clinical and Imaging Fused Deep Learning Model Matches Expert Clinician Prediction of 90-Day Stroke Outcomes

临床和成像融合的深度学习模型与专家临床医生对90天中风结果的预测相匹配

The authors in this study used a deep learning-based predictive model (DLPD) that incorporated DWI and clinical data from the acute period to predict 90-day mRS outcomes and compared its predictions with those made by physicians. The results showed that the clinical and imaging fused deep learning model is noninferior to expert physicians in predicting specific mRS outcomes and unfavorable prognoses.

本研究的作者使用了基于深度学习的预测模型 (DLPD)，该模型结合了DWI和急性期的临床数据来预测90天的mRS结果，并将其预测与医生的预测进行了比较。结果表明，临床和影像学融合的深度学习模型在预测特定mRS结果和不良预后方面不劣于专家医师。

REF: Liu Y, Shah P, Yu Y, et al. A Clinical and Imaging Fused Deep Learning Model Matches Expert Clinician Prediction of 90-Day Stroke Outcomes. AJNR Am J Neuroradiol. 2024;45(4):406-411. Published 2024 Apr 8. doi:10.3174/ajnr.A8140 PMID: 38331959

Predictors of In-Stent Stenosis Following the Implantation of Pipeline Embolization Devices for the Treatment of Aneurysms Located at or beyond the Circle of Willis in the Anterior Circulation

植入PED装置治疗位于或超出前循环Willis环的动脉瘤后支架内狭窄的预测因素

In-stent stenosis is commonly observed after stent implantation. There is no consensus on the contributing factors for in-stent stenosis, especially for aneurysms located at or beyond the circle of Willis in the anterior circulation. This study aimed to investigate the morbidity and determinants of in-stent stenosis in distal anterior circulation aneurysms following the implantation of Pipeline Embolization Devices. Compared with the on-label use of Pipeline Embolization Devices, the rate of in-stent stenosis did not obviously increase when treating distal anterior circulation aneurysms with these devices. The incidence of in-stent stenosis was 36.47% when defined as a lumen diameter loss of >25%, and 15.2% when defined as a lumen diameter loss of >50%. Stent-size selection and biochemical indicators can potentially impact the incidence of in-stent stenosis.

支架内狭窄通常在支架植入后观察到。对于支架内狭窄的影响因素尚无共识，尤其是对于位于前循环Willis环或其外的动脉瘤。这项研究旨在研究植入PED装置后远端前循环动脉瘤中支架内狭窄的发病率和决定因素。与标签上使用PED装置相比，使用这些装置治疗远端前循环动脉瘤时，支架内狭窄率并未明显增加。当定义为管腔直径损失> 25% 时，支架内狭窄的发生率36.47%，当定义为管腔直径损失> 50% 时，支架内狭窄的发生率15.2%。支架尺寸选择和生化指标可能会影响支架内狭窄的发生率。

REF: Ma Y, Deng X, Chen J, et al. Predictors of In-Stent Stenosis Following the Implantation of Pipeline Embolization Devices for the Treatment of Aneurysms Located at or beyond the Circle of Willis in the Anterior Circulation. AJNR Am J Neuroradiol. Published online February 22, 2024. doi:10.3174/ajnr.A8144 PMID: 38388683