Role of Hypoperfusion Intensity Ratio in Vessel Occlusions: A Review on Safety and Clinical Outcomes

低灌注强度比在血管闭塞中的作用：安全性和临床结局综述

The hypoperfusion intensity ratio (HIR) is a quantitative metric used in vascular occlusion imaging to evaluate the extent of brain tissue at risk due to hypoperfusion. Defined as the ratio of tissue volume with a time-to-maximum (Tmax) of >10 seconds to that of >6 seconds, HIR assists in differentiating between the salvageable penumbra and the irreversibly injured core infarct. This review explores the role of HIR in assessing clinical outcomes and guiding treatment strategies, including mechanical thrombectomy and thrombolytic therapy, for patients with large-vessel occlusions (LVOs). Evidence suggests that higher HIR values are associated with worse clinical outcomes, indicating more severe tissue damage and reduced potential for salvage through reperfusion. Additionally, HIR demonstrates predictive accuracy regarding infarct growth, collateral flow, and the risk of reperfusion hemorrhage. It has shown superiority over traditional metrics, such as core infarct volume, in predicting functional outcomes. HIR offers valuable insights for risk stratification and treatment planning in patients with LVOs and distal medium vessel occlusions. Incorporating HIR into clinical practice enhances patient care by improving decision-making processes, promoting timely interventions, and optimizing postintervention management to minimize complications and improve recovery outcomes.

低灌注强度比（HIR）是血管闭塞影像学中用于评估因低灌注而处于危险状态的脑组织范围的一种定量指标。它被定义为最大时间（Tmax）>10 秒的组织体积与 Tmax>6 秒的组织体积之比，有助于区分可挽救的半暗带和不可逆损伤的核心梗死灶。本综述探讨了 HIR 在评估大血管闭塞（LVO）患者临床结局和指导治疗策略（包括机械取栓和溶栓治疗）方面的作用。有证据表明，HIR 值越高，临床结局越差，这表明组织损伤更严重，通过再灌注挽救组织的可能性更低。此外，HIR 在预测梗死灶扩大、侧支循环血流和再灌注出血风险方面具有预测准确性。在预测功能结局方面，它已显示出优于核心梗死灶体积等传统指标。HIR 为 LVO 和远端中等血管闭塞患者的风险分层和治疗规划提供了有价值的见解。将 HIR 纳入临床实践可通过改善决策过程、促进及时干预以及优化干预后管理来减少并发症并改善康复结局，从而提高患者护理质量。

REF: Rehman S, Nadeem A, Kasi ABU, et al. Role of Hypoperfusion Intensity Ratio in Vessel Occlusions: A Review on Safety and Clinical Outcomes. AJNR Am J Neuroradiol. 2025;46(6):1069-1081. Published 2025 Jun 3. doi:10.3174/ajnr.A8557 PMID: 39477546 PMCID: PMC12152793

A Review of Intracranial Aneurysm Imaging Modalities, from CT to State-of-the-Art MR

颅内动脉瘤影像学检查方法综述：从 CT 到最先进的磁共振成像

This review article covers the established imaging modalities (eg, CT, CTA, DSA, FLAIR, 3D TOF-MRA, contrast-enhanced MRA) and novel MR techniques (MR vessel wall imaging, dynamic contrast-enhanced MRI, computational fluid dynamics) of intracranial aneurysm evaluation. Artificial intelligence software and its integration into diagnostic and risk-stratification pipelines for intracranial aneurysms are also discussed.

这篇综述文章涵盖了颅内动脉瘤评估的成熟影像学检查方法（如 CT、CT 血管造影、数字减影血管造影、液体衰减反转恢复序列、三维时间飞跃法磁共振血管造影、对比增强磁共振血管造影）和新型磁共振技术（磁共振血管壁成像、动态对比增强磁共振成像、计算流体动力学）。文中还讨论了人工智能软件及其在颅内动脉瘤诊断和风险分层流程中的应用。

REF: Allaw S, Khabaz K, Given TC, et al. A Review of Intracranial Aneurysm Imaging Modalities, from CT to State-of-the-Art MR. AJNR Am J Neuroradiol. 2025;46(6):1082-1092. Published 2025 Jun 3. doi:10.3174/ajnr.A8549 PMID: 39443148 PMCID: PMC12152792

Gender Differences in Medicare Practice and Payment of Neuroradiologists

神经放射科医生在医疗保险诊疗实践与支付方面的性别差异

Female neuroradiologists in clinical practice are outnumbered by their male counterparts. However, it is unknown whether there are differences in practice patterns and Medicare billing and payment between female and male neuroradiologists. Our aim was to compare representation, practice range, clinical productivity, and Medicare payments for female and male neuroradiologists. Female neuroradiologists were underrepresented, charged less, and received less overall payment compared with their male counterparts. Female neuroradiologists provided a smaller range and number of services, and a greater proportion of female neuroradiologists billed for higher-paying services. Further studies are needed to assess differences in part-time work and subspecialty representation to determine their impact.

在临床实践中，女性神经放射科医生的数量少于男性同行。然而，目前尚不清楚女性和男性神经放射科医生在执业模式、医疗保险计费和支付方面是否存在差异。我们的目的是比较女性和男性神经放射科医生的从业比例、执业范围、临床工作量以及医疗保险支付情况。与男性同行相比，女性神经放射科医生从业比例较低，收费较少，总体收入也较少。女性神经放射科医生提供的服务种类和数量较少，但有更高比例的女性神经放射科医生为高收费服务项目计费。需要进一步开展研究，评估兼职工作和亚专业从业比例的差异，以确定其影响。

REF: Malhotra A, Lee C, Khunte M, et al. Gender Differences in Medicare Practice and Payment of Neuroradiologists. AJNR Am J Neuroradiol. 2025;46(6):1093-1099. Published 2025 Jun 3. doi:10.3174/ajnr.A8633 PMID: 40461255 PMCID: PMC12152790

Deep Medullary Vein Integrity and Relationships with Small Vessel Disease and Interstitial Diffusivity Measures in Patients with a Recent Small Subcortical Infarct

近期发生小的皮质下梗死患者的深部髓静脉完整性及其与小血管病和间质扩散率指标的关系

In this retrospective observational study, the authors assessed how DMV integrity relates to MRI-based SVD severity markers and glymphatic function assessed by DTI measures in patients with a recent small subcortical infarct. DMV disruption demonstrated a weak association with SVD, influenced by confounding factors, and a strong relationship with microstructural WM integrity and free water content, suggesting the potential involvement of extracellular fluid in mechanisms leading to vein disruption.

在这项回顾性观察性研究中，作者评估了在近期发生小的皮质下梗死的患者中，深部髓静脉（DMV）完整性与基于磁共振成像（MRI）的脑小血管病（SVD）严重程度标志物以及通过弥散张量成像（DTI）指标评估的类淋巴系统功能之间的关系。DMV 破坏与 SVD 呈弱关联，且受混杂因素影响，而与白质微观结构完整性和自由水含量密切相关，这表明细胞外液可能参与了导致静脉破坏的机制。

REF: Brenlla C, Sozzi C, Girona A, et al. Deep Medullary Vein Integrity and Relationships with Small Vessel Disease and Interstitial Diffusivity Measures in Patients with a Recent Small Subcortical Infarct. AJNR Am J Neuroradiol. 2025;46(6):1103-1111. Published 2025 Jun 3. doi:10.3174/ajnr.A8591 PMID: 39572199 PMCID: PMC12152810

Decreased Visibility of Deep Medullary Vein Associated with Cerebral Small Vessel Disease Burden through Increased Interstitial Fluid in White Matter

深部髓静脉显影减低与脑小血管病负荷相关，其机制为白质间质液增多

Decreased visibility of deep medullary veins (DMVs) on susceptibility-weighted imaging (SWI) has been reported in individuals with cerebral small vessel disease (CSVD). This study aims to explore the relationship between the decreased visibility of the DMV, interstitial fluid (ISF), and the CSVD burden. The DMV score was associated with the CSVD burden through FW in white matter in individuals with CSVD and may describe a venous aspect of the pathogenesis of the CSVD burden.

在脑小血管病（CSVD）患者中，已有报道称磁敏感加权成像（SWI）显示深部髓静脉（DMV）的显影降低。本研究旨在探讨DMV显影降低、组织间液（ISF）与CSVD负荷之间的关系。在CSVD患者中，DMV评分通过白质中的自由水（FW）与CSVD负荷相关，且可能反映了CSVD负荷发病机制中的静脉因素。

REF: Xu Z, Lan H, Lei X, Zhang H, Xiong F, Wang L. Decreased Visibility of Deep Medullary Vein Associated with Cerebral Small Vessel Disease Burden through Increased Interstitial Fluid in White Matter. AJNR Am J Neuroradiol. 2025;46(6):1112-1119. Published 2025 Jun 3. doi:10.3174/ajnr.A8632 PMID: 40374538 PMCID: PMC12152781

Safety and Efficacy of the Neuroform Atlas Stent for Treatment of Intracranial Aneurysms: A Systematic Review, Meta-Analysis, and Meta-Regression

Neuroform Atlas支架治疗颅内动脉瘤的安全性和有效性：系统评价、荟萃分析和荟萃回归

Intracranial aneurysms (IAs) are the major cause of subarachnoid hemorrhage. Stent-assisted coiling, especially with the Neuroform Atlas stent (NAS), has proved more effective than coiling alone for treating these aneurysms. Although the generalizability of our findings is limited, this study demonstrates that the NAS is highly effective for treating IAs, with high occlusion rates and a low incidence of adverse events. The stent's performance, supported by comprehensive analysis, highlights its safety and efficacy in managing both ruptured and unruptured aneurysms.

颅内动脉瘤（IAs）是蛛网膜下腔出血的主要原因。支架辅助弹簧圈栓塞术，尤其是使用Neuroform Atlas支架（NAS），已被证明在治疗这些动脉瘤方面比单纯弹簧圈栓塞术更有效。尽管我们的研究结果的可推广性有限，但本研究表明，NAS治疗颅内动脉瘤非常有效，闭塞率高且不良事件发生率低。通过全面分析证实，该支架在治疗破裂和未破裂动脉瘤方面的表现凸显了其安全性和有效性。

REF: Akram U, Ahmed S, Nadeem ZA, et al. Safety and Efficacy of the Neuroform Atlas Stent for Treatment of Intracranial Aneurysms: A Systematic Review, Meta-Analysis, and Meta-Regression. AJNR Am J Neuroradiol. 2025;46(6):1120-1129. Published 2025 Jun 3. doi:10.3174/ajnr.A8593 PMID: 39578103 PMCID: PMC12152791

Effectiveness and Safety of Mechanical Thrombectomy in Mild Stroke due to Large-Vessel Occlusion: Insights from the ASSIST Registry

大血管闭塞所致轻度卒中患者机械取栓术的有效性和安全性：来自ASSIST注册研究的见解

Mechanical thrombectomy (MT) is effective for acute ischemic stroke, yet its indication in mild stroke remains unclear. This study evaluates the effectiveness and safety of MT in patients with low NIHSS scores and assesses the impact of different MT strategies on procedural success and clinical outcomes. MT is effective and safe in patients with mild stroke. Procedural success did not vary among MT techniques in mild stroke. The total number of passes predict END, which suggests a causal pathway that requires further exploration.

机械取栓术（MT）对急性缺血性卒中有效，但在轻度卒中中的适应证仍不明确。本研究评估了低美国国立卫生研究院卒中量表（NIHSS）评分患者接受MT的有效性和安全性，并评估了不同MT策略对手术成功率和临床结局的影响。MT对轻度卒中患者是有效且安全的。在轻度卒中患者中，不同MT技术的手术成功率无差异。取栓次数总数可预测早期神经功能恶化（END），这提示存在一条需要进一步探索的因果路径。

REF: Hohenstatt S, Vollherbst DF, Miralbés S, et al. Effectiveness and Safety of Mechanical Thrombectomy in Mild Stroke due to Large-Vessel Occlusion: Insights from the ASSIST Registry. AJNR Am J Neuroradiol. 2025;46(6):1130-1136. Published 2025 Jun 3. doi:10.3174/ajnr.A8613 PMID: 39627006 PMCID: PMC12152780

Flow Diversion for the Treatment of Distal Circulation Aneurysms: A Randomized Comparison

血流导向装置治疗远端循环动脉瘤：一项随机对照研究

Flow diversion (FD) has expanded beyond initial indications (proximal carotid artery aneurysms) to include distal circulation aneurysms (on the anterior, middle, or posterior cerebral arteries). Our objective was to examine results obtained from aneurysms in these locations in the Flow Diversion in Intracranial Aneurysm Treatment Trial (FIAT), which compared FD with alternative standard management options (ASMO). Distal circulation aneurysms treated with FDs in FIAT showed an encouraging trend, but this analysis was underpowered. Further randomized trials are needed.

血流导向（FD）技术的应用已从最初的适应证（颈内动脉近端动脉瘤）扩展到包括远端循环动脉瘤（位于大脑前动脉、大脑中动脉或大脑后动脉）。我们的目的是研究颅内动脉瘤血流导向治疗试验（FIAT）中这些部位动脉瘤的治疗结果，该试验将血流导向技术与其他标准治疗方案（ASMO）进行了比较。在FIAT试验中，采用血流导向技术治疗的远端循环动脉瘤显示出令人鼓舞的趋势，但这一分析的检验效能不足。因此，需要开展更多的随机试验。

REF: Boisseau W, Darsaut TE, Fahed R, et al. Flow Diversion for the Treatment of Distal Circulation Aneurysms: A Randomized Comparison. AJNR Am J Neuroradiol. 2025;46(6):1137-1142. Published 2025 Jun 3. doi:10.3174/ajnr.A8620 PMID: 39694616 PMCID: PMC12152805

Factors Associated with Major Re-Recanalization following Second Coiling for Recanalized Aneurysms: A Multicenter Experience over 20 Years during Long-Term Follow-up

再通动脉瘤二次弹簧圈栓塞术后发生主要再通的相关因素：一项超过20年长期随访的多中心研究经验

Second coiling for recanalized aneurysms can mitigate the risk of delayed rupture, though re-recanalization may still occur. However, factors associated with re-recanalization after second coiling for recanalized aneurysms have yet to be adequately investigated. The present study explored a large, multicenter data set accumulated over 20 years to identify factors associated with major re-recanalization after second coiling for recanalized aneurysms. The main risk factor for major re-recanalization after second coiling of recanalized aneurysms was neck size at first coiling, and protective factors included stent-assisted coiling, use of an IMC, and complete occlusion at second coiling. Second coiling for recanalized aneurysms may reduce the risk of major re-recanalization by using a stent or IMC and achieving complete occlusion.

对于再通动脉瘤进行二次弹簧圈栓塞可降低延迟破裂的风险，尽管仍可能发生再次再通。然而，再通动脉瘤二次弹簧圈栓塞后发生再次再通的相关因素尚未得到充分研究。本研究对20年来积累的大型多中心数据集进行了分析，以确定再通动脉瘤二次弹簧圈栓塞后发生严重再次再通的相关因素。再通动脉瘤二次弹簧圈栓塞后发生严重再次再通的主要危险因素是首次弹簧圈栓塞时的瘤颈大小，保护因素包括支架辅助弹簧圈栓塞、使用可解脱微导管（IMC）以及二次弹簧圈栓塞时完全闭塞。对于再通动脉瘤，使用支架或可解脱微导管并实现完全闭塞的二次弹簧圈栓塞可能降低严重再次再通的风险。

REF: Fuga M, Ishibashi T, Kan I, et al. Factors Associated with Major Re-Recanalization following Second Coiling for Recanalized Aneurysms: A Multicenter Experience over 20 Years during Long-Term Follow-up. AJNR Am J Neuroradiol. 2025;46(6):1143-1151. Published 2025 Jun 3. doi:10.3174/ajnr.A8671 PMID: 40441880 PMCID: PMC12152788