1.Advances in Acute Ischemic Stroke Treatment: Current Status and Future Directions

急性缺血性卒中治疗研究进展：现状与未来

The management of acute ischemic stroke has undergone a paradigm shift in the past decade. This has been spearheaded by the emergence of endovascular thrombectomy, along with advances in medical therapy, imaging, and other facets of stroke care. Herein, we present an updated review of the various stroke trials that have impacted and continue to transform stroke management. It is critical for the radiologist to stay abreast of the ongoing developments to provide meaningful input and remain a useful part of the stroke team.

在过去的十年中，急性缺血性卒中的治疗模式发生了转变。这是由于血管内血栓切除术的出现，以及医学治疗、成像和中风护理的其他方面的进步。在此，我们对影响并继续改变卒中管理的各种卒中试验进行了最新回顾。对于放射科医生来说，紧跟正在进行的发展是至关重要的，这样才能提供有意义的意见，并继续成为中风团队中有用的一部分。

REF: Bathla G, Ajmera P, Mehta PM, et al. Advances in Acute Ischemic Stroke Treatment: Current Status and Future Directions. AJNR Am J Neuroradiol. 2023;44(7):750-758. doi:10.3174/ajnr.A7872

PMID: 37202115 PMCID: PMC10337623

2.Crowd-Sourced Deep Learning for Intracranial Hemorrhage Identification: Wisdom of Crowds or Laissez-Faire

用于识别颅内出血的众源深度学习：人群的智慧还是放任自流

Researchers and clinical radiology practices are increasingly faced with the task of selecting the most accurate artificial intelligence tools from an ever-expanding range. In this study, we sought to test the utility of ensemble learning for determining the best combination from 70 models trained to identify intracranial hemorrhage. Furthermore, we investigated whether ensemble deployment is preferred to use of the single best model. It was hypothesized that any individual model in the ensemble would be outperformed by the ensemble. None of the ensemble learning methods outperformed the accuracy of the single best convolutional neural network, at least in the context of intracranial hemorrhage detection.

研究人员和临床放射学实践越来越面临从不断扩大的范围中选择最准确的人工智能工具的任务。在这项研究中，我们试图测试集合学习在从70个模型中确定最佳组合的有效性，这些模型被训练来识别颅内出血。此外，我们还研究了整体部署是否优于单一最佳模型的使用。当时的假设是，合唱团中的任何一位模特都会被合唱团超越。没有一种集成学习方法比单一的最佳卷积神经网络的准确性更好，至少在颅内出血检测方面是这样。

REF: Hofmeijer EIS, Tan CO, van der Heijden F, Gupta R. Crowd-Sourced Deep Learning for Intracranial Hemorrhage Identification: Wisdom of Crowds or Laissez-Faire. AJNR Am J Neuroradiol. 2023;44(7):762-767.doi:10.3174/ajnr.A7902

PMID: 37290819 PMCID: PMC10337616

3. Investigation of Brain Iron in Niemann-Pick Type C: A 7T Quantitative Susceptibility Mapping Study

Niemann-Pick C型脑铁的7T定量磁化率图研究

While brain iron dysregulation has been observed in several neurodegenerative disorders, its association with the progressive neurodegeneration in Niemann-Pick type C is unknown. Systemic iron abnormalities have been reported in patients with Niemann-Pick type C and in animal models of Niemann-Pick type C. In this study, we examined brain iron using quantitative susceptibility mapping MR imaging in individuals with Niemann-Pick type C compared with healthy controls. Our findings suggest iron deposition in the pulvinar nucleus in Niemann-Pick type C disease, which is associated with thalamic atrophy and disease severity. This preliminary evidence supports the link between iron and neurodegeneration in Niemann-Pick type C, in line with existing literature on other neurodegenerative disorders.

虽然在几种神经退行性疾病中观察到了脑铁失调，但它与Niemann-Pick C型进行性神经退变的关联尚不清楚。已有报道在Niemann-Pick C型患者和Niemann-Pick C型动物模型中发现全身性铁异常。在这项研究中，我们使用定量磁化率图MR成像检测了与健康对照组比较的Niemann-Pick C型患者的脑铁。我们的发现提示在Niemann-Pick C型疾病中枕核中有铁沉积，这与丘脑萎缩和疾病严重程度有关。这一初步证据支持Niemann-Pick C型神经退行性变与铁之间的联系，这与现有的关于其他神经退行性疾病的文献一致。

REF: Ravanfar P, Syeda WT, Rushmore RJ, et al. Investigation of Brain Iron in Niemann-Pick Type C: A 7T Quantitative Susceptibility Mapping Study. AJNR Am J Neuroradiol. 2023;44(7):768-775. doi:10.3174/ajnr.A7894

PMID: 37348967 PMCID: PMC10337610

4. Choroid Plexus Calcification Correlates with Cortical Microglial Activation in Humans: A Multimodal PET, CT, MRI Study

脉络丛钙化与皮质小胶质细胞激活相关：一项多模式PET、CT、MRI研究

The choroid plexus (CP) within the brain ventricles is well-known to produce cerebrospinal fluid (CSF). Recently, the CP has been recognized as critical in modulating inflammation. MRI-measured CP enlargement has been reported in neuroinflammatory disorders like MS as well as with aging and neurodegeneration. The basis of MRI-measured CP enlargement is unknown. On the basis of tissue studies demonstrating CP calcification as a common pathology associated with aging and disease, we hypothesized that previously unmeasured CP calcification contributes to MRI-measured CP volume and may be more specifically associated with neuroinflammation. Choroid plexus calcification can be accurately and automatically quantified using low-dose CT and MRI. Choroid plexus calcification-but not choroid plexus volume-predicted cortical inflammation. Previously unmeasured choroid plexus calcium may explain recent reports of choroid plexus enlargement in human inflammatory and other diseases. Choroid plexus calcification may be a specific and relatively easily acquired biomarker for neuroinflammation and choroid plexus pathology in humans.

众所周知，脑室内的脉络丛(CP)会产生脑脊液(CSF)。最近，CP被认为在调节炎症方面起着关键作用。MRI测量的CP增大在MS等神经炎性疾病以及衰老和神经退行性变中已有报道。MRI测量的脑脊液增大的基础尚不清楚。在组织研究表明CP钙化是一种与年龄和疾病相关的常见病理基础上，我们假设以前未测量的CP钙化有助于MRI测量的CP体积，并且可能与神经炎症更具特异性。脉络丛钙化可以利用低剂量CT和MRI进行准确和自动的量化。脉络丛钙化--但不能预测脉络丛体积--可以预测皮质炎。以前未测量到的脉络丛钙离子可能解释了最近关于人类炎症和其他疾病中脉络丛增大的报道。脉络丛钙化可能是人类神经炎和脉络丛病理的一种特异且相对容易获得的生物标志物。

REF: Butler T, Wang XH, Chiang GC, et al. Choroid Plexus Calcification Correlates with Cortical Microglial Activation in Humans: A Multimodal PET, CT, MRI Study. AJNR Am J Neuroradiol. 2023;44(7):776-782. doi:10.3174/ajnr.A7903

PMID: 37321857 PMCID: PMC10337614

5.Cost-Effectiveness Analysis of 68Ga-DOTATATE PET/MRI in Radiotherapy Planning in Patients with Intermediate-Risk Meningioma

中危脑膜瘤放射治疗计划中68Ga-DATATE-PET/MRI的成本-效果分析

While contrast-enhanced MR imaging is the criterion standard in meningioma diagnosis and treatment response assessment, gallium68Ga-DOTATATE PET/MR imaging has increasingly demonstrated utility in meningioma diagnosis and management. Integrating68Ga-DOTATATE PET/MR imaging in postsurgical radiation planning reduces the planning target volume and organ-at-risk dose. However,68Ga-DOTATATE PET/MR imaging is not widely implemented in clinical practice due to higher perceived costs. Our study analyzes the cost-effectiveness of68Ga-DOTATATE PET/MR imaging for postresection radiation therapy planning in patients with intermediate-risk meningioma. 68Ga-DOTATATE PET/MR imaging as an adjunct imaging technique is cost-effective in postoperative treatment planning in patients with meningiomas. Most important, the model results show that the sensitivity and specificity cost-effective thresholds of68Ga-DOTATATE PET/MR imaging could be attained in clinical practice.

对比增强磁共振成像是脑膜瘤诊断和治疗反应评估的标准，而镓68Ga-DOTATE PET/MR成像在脑膜瘤的诊断和治疗中显示出越来越多的实用价值。在术后放疗计划中整合68Ga-DOTATE PET/MR成像，减少了计划靶区体积和危险器官剂量。然而，由于认为成本较高，68Ga-DOTATE PET/MR成像并未广泛应用于临床实践。我们的研究分析了68Ga-DOTATE PET/MR成像在中危脑膜瘤患者术后放射治疗计划中的成本-效果。68Ga-DOTATATE PET/MR成像作为一种辅助成像技术，在脑膜瘤患者的术后治疗计划中是一种经济有效的方法。最重要的是，模型结果表明，68Ga-DOTATE PET/MR成像的灵敏度和特异度可以在临床上达到成本效益阈值。

REF: Rodriguez J, Martinez G, Mahase S, et al. Cost-Effectiveness Analysis of 68Ga-DOTATATE PET/MRI in Radiotherapy Planning in Patients with Intermediate-Risk Meningioma. AJNR Am J Neuroradiol. 2023;44(7):783-791. doi:10.3174/ajnr.A7901

PMID: 37290818 PMCID: PMC10337622

6.Sex-Specific Patterns of Cerebral Atrophy and Enlarged Perivascular Spaces in Patients with Cerebral Amyloid Angiopathy and Dementia

淀粉样脑血管病和痴呆患者脑萎缩和血管周围间隙扩大的性别特征

Cerebral amyloid angiopathy is characterized by amyloid β deposition in leptomeningeal and superficial cortical vessels. Cognitive impairment is common and may occur independent of concomitant Alzheimer disease neuropathology. It is still unknown which neuroimaging findings are associated with dementia in cerebral amyloid angiopathy and whether they are modulated by sex. This study compared MR imaging markers in patients with cerebral amyloid angiopathy with dementia or mild cognitive impairment or who are cognitively unimpaired and explored sex-specific differences. Medial temporal lobe atrophy was more prominent in men with dementia, whereas women showed a higher number of enlarged perivascular spaces in the centrum semiovale. Overall, this finding suggests differential pathophysiologic mechanisms with sex-specific neuroimaging patterns in cerebral amyloid angiopathy.

脑淀粉样血管病的特征是软脑膜和皮质浅血管中淀粉样蛋白β的沉积。认知障碍是常见的，可独立于伴随的阿尔茨海默病神经病理而发生。目前还不清楚哪些神经影像表现与脑淀粉样血管病的痴呆有关，也不知道它们是否受性别的影响。这项研究比较了患有痴呆或轻度认知障碍的脑淀粉样血管病患者或认知正常的患者的磁共振成像标记物，并探讨了性别差异。内侧颞叶萎缩在男性痴呆症患者中更为突出，而女性在半卵圆中心血管周围间隙扩大的数量更多。总体而言，这一发现提示大脑淀粉样血管病的不同病理生理机制与性别特异性的神经成像模式不同。

REF: Pinho J, Almeida FC, Araújo JM, et al. Sex-Specific Patterns of Cerebral Atrophy and Enlarged Perivascular Spaces in Patients with Cerebral Amyloid Angiopathy and Dementia. AJNR Am J Neuroradiol. 2023;44(7):792-798. doi:10.3174/ajnr.A7900

PMID: 37290817 PMCID: PMC10337609

7.MR Imaging Findings in a Large Population of Autoimmune Encephalitis

大量自身免疫性脑炎的MRI表现

Autoimmune encephalitis is a rare condition in which autoantibodies attack neuronal tissue, causing neuropsychiatric disturbances. This study sought to evaluate MR imaging findings associated with subtypes and categories of autoimmune encephalitis. Sixty-one percent of patients with autoimmune encephalitis had abnormal brain MR imaging findings at symptom onset, most commonly involving the limbic system. Susceptibility artifact is rare and makes autoimmune encephalitis less likely as a diagnosis. Brainstem and cerebellar involvement were more common in group 1, while leptomeningeal enhancement was more common in group 2.

自身免疫性脑炎是一种罕见的疾病，自身抗体攻击神经元组织，导致神经精神障碍。这项研究试图评估与自身免疫性脑炎的亚型和类别相关的磁共振成像表现。61%的自身免疫性脑炎患者在症状开始时有异常的脑MRI表现，最常见的是边缘系统。易感性伪影很少见，使自身免疫性脑炎不太可能被诊断为脑炎。脑干和小脑受累在组1中更常见，而软脑膜强化在组2中更常见。

REF: Gillon S, Chan M, Chen J, et al. MR Imaging Findings in a Large Population of Autoimmune Encephalitis. AJNR Am J Neuroradiol. 2023;44(7):799-806. doi:10.3174/ajnr.A7907

PMID: 37385678 PMCID: PMC10337613

8.Early Detection of Underlying Cavernomas in Patients with Spontaneous Acute Intracerebral Hematomas

自发性急性脑内血肿患者潜在海绵状血肿的早期发现

Early identification of the etiology of spontaneous acute intracerebral hemorrhage is essential for appropriate management. This study aimed to develop an imaging model to identify cavernoma-related hematomas. An imaging model including ovoid/spherical shape, regular margins, absence of extralesional hemorrhage, and absence of peripheral rim enhancement accurately identifies cavernoma-related acute spontaneous cerebral hematomas in young patients.

早期确定自发性急性脑出血的病因是进行适当治疗的关键。这项研究的目的是开发一种影像模型来识别海绵状肿瘤相关血肿。成像模型包括卵圆形/球形、边缘规则、无局灶外出血、无周边强化，可准确识别年轻患者海绵状瘤相关的急性自发性脑血肿。

REF: Bani-Sadr A, Eker OF, Cho TH, et al. Early Detection of Underlying Cavernomas in Patients with Spontaneous Acute Intracerebral Hematomas. AJNR Am J Neuroradiol. 2023;44(7):807-813. doi:10.3174/ajnr.A7914

PMID: 37385679 PMCID: PMC10337618

9.Perifocal Edema in Patients with Meningioma is Associated with Impaired Whole-Brain Connectivity as Detected by Resting-State fMRI

静息状态功能磁共振检测脑膜瘤患者周围水肿与全脑连接受损相关

Meningiomas are intracranial tumors that usually carry a benign prognosis. Some meningiomas cause perifocal edema. Resting-state fMRI can be used to assess whole-brain functional connectivity, which can serve as a marker for disease severity. Here, we investigated whether the presence of perifocal edema in preoperative patients with meningiomas leads to impaired functional connectivity and if these changes are associated with cognitive function. Resting-state fMRI showed a significant association between impaired functional connectivity and perifocal edema, but not tumor volume, in patients with meningiomas. We demonstrated that better neurocognitive function was associated with less impairment of functional connectivity. This result shows that our resting-state fMRI marker indicates a detrimental influence of peritumoral brain edema on global functional connectivity in patients with meningiomas.

脑膜瘤是一种颅内肿瘤，通常预后良好。一些脑膜瘤会引起病灶周围的水肿。静息状态的功能磁共振成像可以用来评估全脑功能连接，这可以作为疾病严重程度的标志。在这里，我们调查了脑膜瘤患者术前病灶周围水肿的存在是否导致功能连接受损，以及这些变化是否与认知功能有关。静息功能磁共振成像显示脑膜瘤患者功能连接性受损与病灶周围水肿显著相关，但与肿瘤体积无关。我们证明，较好的神经认知功能与较少的功能连通性损伤相关。这一结果表明，我们的静息状态fMRI标记物表明，脑膜瘤患者的瘤周脑水肿对整体功能连通性有不利影响。

REF: Stoecklein VM, Wunderlich S, Papazov B, et al. Perifocal Edema in Patients with Meningioma is Associated with Impaired Whole-Brain Connectivity as Detected by Resting-State fMRI. AJNR Am J Neuroradiol. 2023;44(7):814-819. doi:10.3174/ajnr.A7915

PMID: 37385680 PMCID: PMC10337612