The Monro-Kellie Doctrine: A Review and Call for Revision

蒙罗-凯利主义：回顾与呼唤修正

The Monro-Kellie doctrine is a well-accepted principle of intracranial hemodynamics. It has undergone few consequential revisions since it was established. Its principle is straightforward: The combined volume of neuronal tissue, blood, and CSF is constant. To maintain homeostatic intracranial pressure, any increase or decrease in one of these elements leads to a reciprocal and opposite change in the others. The Monro-Kellie doctrine assumes a rigid, unadaptable calvaria. Recent studies have disproven this assumption. The skull expands and grows in response to pathologic changes in intracranial pressure. In this review, we outline what is known about calvarial changes in the setting of pressure dysregulation and suggest a revision to the Monro-Kellie doctrine that includes an adaptable skull as a fourth component.

Monro-Kellie学说是公认的颅内血流动力学原理。自成立以来，它几乎没有进行过相应的修改。它的原理很简单：神经元组织、血液和脑脊液的总和是恒定的。为了维持动态平衡的颅内压，这些元素中的任何一个的增加或减少都会导致其他元素的相互和相反的变化。Monro-Kellie学说假定头盖骨僵硬，无法适应。最近的研究证明了这一假设是错误的。颅骨随着颅内压的病理变化而膨胀和生长。在这篇综述中，我们概述了关于压力失调背景下颅骨变化的已知情况，并建议对Monro-Kellie学说进行修订，其中包括作为第四个组成部分的适应性颅骨。

Benson JC, Madhavan AA, Cutsforth-Gregory JK, Johnson DR, Carr CM. The Monro-Kellie Doctrine: A Review and Call for Revision [published online ahead of print, 2022 Dec 1]. AJNR Am J Neuroradiol. 2022;10.3174/ajnr.A7721. doi:10.3174/ajnr.A7721 PMID: 36456084

Viz.ai Implementation of Stroke Augmented Intelligence and Communications Platform to Improve Indicators and Outcomes for a Comprehensive Stroke Center and Network

Viz.ai实施卒中增强智能和通信平台，以改善综合卒中中心和网络的指标和成果

Background and purpose: Comprehensive stroke centers continually strive to narrow neurointerventional time metrics. Although process improvements have been put in place to streamline workflows, complex pathways, disparate imaging locations, and fragmented communications all highlight the need for continued improvement. Conclusions: There was an immediate improvement following Viz.ai implementation for both direct arriving and telemedicine transfer thrombectomy cases. In the greatest opportunity subset (direct arriving large-vessel occlusion-OffHours: direct arriving cases requiring team mobilization off-hours), we noted a 39% improvement. With Viz.ai, we noted that immediate access to images and streamlined communications improved door-to-groin time metrics for thrombectomy. These results have implications for future care processes and can be a model for centers striving to optimize workflow and improve thrombectomy timeliness.

背景和目的：综合性卒中中心不断努力缩小神经干预时间指标。虽然已经进行了流程改进以简化工作流程，但复杂的路径、不同的成像位置和零散的通信都突显了继续改进的必要性。 结论：在实施Viz.ai后，直接到达和远程医疗转移血栓切除术的病例立即得到改善。在最大机会子集(直达大血管闭塞-OFHour：需要在非工作时间动员团队的直达病例)中，我们注意到改善了39%。通过Viz.ai，我们注意到即时访问图像和简化的通信改善了血栓切除术的门到腹股沟时间指标。这些结果对未来的护理流程具有启示意义，并可作为中心努力优化工作流程和提高血栓切除及时性的典范。

Figurelle ME, Meyer DM, Perrinez ES, et al. Viz.ai Implementation of Stroke Augmented Intelligence and Communications Platform to Improve Indicators and Outcomes for a Comprehensive Stroke Center and Network [published online ahead of print, 2022 Dec 8]. AJNR Am J Neuroradiol. 2022;10.3174/ajnr.A7716. doi:10.3174/ajnr.A7716 PMID: 36574318

FLAIR Vascular Hyperintensities as a Surrogate of Collaterals in Acute Stroke: DWI Matters

FLAIR血管高信号作为急性卒中侧支循环的替代物：磁共振弥散加权成像

We aimed to compare the value of FLAIR vascular hyperintensities-DWI mismatch versus all-FLAIR vascular hyperintensities for collateral assessment using PWI-derived collateral flow maps as a reference. Conclusions: In acute ischemic stroke with large-vessel occlusion, the extent of FLAIR vascular hyperintensities does not reliably reflect collateral status unless one accounts for DWI.

我们的目的是比较FLAIR血管高信号-DWI不匹配和全FLAIR血管高信号在侧支循环评估中的价值，以PWI获得的侧支血流图为参考。 结论：在大血管闭塞的急性缺血性卒中，FLAIR血管高信号的范围不能可靠地反映侧支循环状态，除非考虑到弥散加权成像。

Legrand L, Le Berre A, Seners P, et al. FLAIR Vascular Hyperintensities as a Surrogate of Collaterals in Acute Stroke: DWI Matters [published online ahead of print, 2022 Dec 15]. AJNR Am J Neuroradiol. 2022;10.3174/ajnr.A7733. doi:10.3174/ajnr.A7733 PMID: 36521962

An Artificial Intelligence Tool for Clinical Decision Support and Protocol Selection for Brain MRI

一种用于脑MRI临床决策支持和方案选择的人工智能工具

The purpose of this study was to assess the potential of an artificial intelligence-based semiautomated tool in reducing the workload and decreasing unwarranted variation in the protocolling process. Conclusions: Our model achieved high accuracy on a standard based on physician consensus. It showed promise as a clinical decision support tool to reduce the workload by automating the protocolling of a sizeable portion of examinations while maintaining high accuracy for the remaining examinations.

这项研究的目的是评估基于人工智能的半自动工具在减少工作量和减少原型整理过程中的不必要差异方面的潜力。 结论：我们的模型在基于医生共识的标准上达到了很高的准确性。它显示了作为临床决策支持工具的前景，通过自动化相当大一部分检查的方案编制，同时保持其余检查的高准确性，从而减少工作量。

Wong KA, Hatef A, Ryu JL, Nguyen XV, Makary MS, Prevedello LM. An Artificial Intelligence Tool for Clinical Decision Support and Protocol Selection for Brain MRI [published online ahead of print, 2022 Dec 15]. AJNR Am J Neuroradiol. 2022;10.3174/ajnr.A7736. doi:10.3174/ajnr.A7736 PMID: 36521960

Association of Left Vertebral Artery Hypoplasia with Posterior Circulation Stroke and the Functional Outcome of Patients with Atrial Fibrillation–Related Cardioembolic Stroke

左椎动脉发育不良与后循环卒中及房颤相关心栓性卒中患者功能结局的关系

we investigated whether left vertebral artery hypoplasia is associated with cardiac embolisms with atrial fibrillation in the posterior circulation and its functional outcomes. Conclusions: Patients with cardioembolic stroke and left vertebral artery hypoplasia had posterior circulation stroke, basilar artery occlusion, and poor functional outcomes after 3 months.

我们调查了左椎动脉发育不良是否与心脏栓塞伴后循环房颤相关，以及其功能结果。 结论：心栓性卒中合并左椎动脉发育不良患者3个月后出现后循环卒中、基底动脉闭塞和功能不良。

Bae JH, Ryu JC, Ha SH, et al. Association of Left Vertebral Artery Hypoplasia with Posterior Circulation Stroke and the Functional Outcome of Patients with Atrial Fibrillation-Related Cardioembolic Stroke [published online ahead of print, 2022 Dec 15]. AJNR Am J Neuroradiol. 2022;10.3174/ajnr.A7738. doi:10.3174/ajnr.A7738 PMID: 36521964

Association between Infarct Location and Hemorrhagic Transformation of Acute Ischemic Stroke following Successful Recanalization after Mechanical Thrombectomy

急性缺血性卒中机械取栓再通成功后梗塞部位与出血性转化的关系

We aimed to evaluate the association between CTP-based ischemic core variables at admission and hemorrhagic transformation after a successful thrombectomy. Conclusions: Subcortical infarcts seen on CTP at admission are associated with hemorrhagic transformation in patients after successful thrombectomy, and subcortical infarct volume may influence the risk of symptomatic intracerebral hemorrhage.

我们的目的是评估入院时基于CTP的缺血核心变量与成功取栓后出血转化之间的关系。 结论：入院时CTP显示的皮质下梗塞与成功取栓后的出血性转化有关，皮质下梗塞体积可能影响症状性脑出血的风险。

Ni H, Lu GD, Hang Y, et al. Association between Infarct Location and Hemorrhagic Transformation of Acute Ischemic Stroke following Successful Recanalization after Mechanical Thrombectomy [published online ahead of print, 2022 Dec 15]. AJNR Am J Neuroradiol. 2022;10.3174/ajnr.A7742. doi:10.3174/ajnr.A7742 PMID: 36521961

Artificial Intelligence–Assisted Evaluation of the Spatial Relationship between Brain Arteriovenous Malformations and the Corticospinal Tract to Predict Postsurgical Motor Defects

人工智能辅助评估脑动静脉畸形与皮质脊髓束空间关系预测术后运动缺陷

Our goal was to use artificial intelligence to predict postsurgical motor defects in patients with brain AVMs involving motor-related areas. Conclusions: The artificial intelligence-based indicator, FN10mm/50mm, can reflect the lesion-fiber spatial relationship and act as a dominant predictor for postsurgical motor defects in patients with brain AVMs involving motor-related areas.

我们的目标是使用人工智能来预测脑动静脉畸形患者术后涉及运动相关区域的运动缺陷。 结论：基于人工智能的FN10 mm/50 mm指标可以反映病变-纤维的空间关系，并可作为预测涉及运动相关区域的脑动静脉畸形患者术后运动缺陷的主要指标。

Jiao Y, Zhang J, Yang X, et al. Artificial Intelligence-Assisted Evaluation of the Spatial Relationship between Brain Arteriovenous Malformations and the Corticospinal Tract to Predict Postsurgical Motor Defects [published online ahead of print, 2022 Dec 22]. AJNR Am J Neuroradiol. 2022;10.3174/ajnr.A7735. doi:10.3174/ajnr.A7735 PMID: 36549849

Automated Estimation of Quantitative Lesion Water Uptake as a Prognostic Biomarker for Patients with Ischemic Stroke and Large-Vessel Occlusion

定量病变吸水率作为缺血性卒中和大血管闭塞患者预后生物标志物的自动评估

Background and purpose: Net water uptake is qualified as an imaging marker of brain edema. We aimed to investigate the ability of net water uptake to predict 90-day functional outcome in patients with acute ischemic stroke and large-vessel occlusion. Conclusions: ASPECTS-net water uptake could independently predict 90-day neurologic outcomes in patients with acute ischemic stroke and large-vessel occlusion. Integrating ASPECTS-net water uptake with clinical models could improve the efficiency of outcome stratification.

背景和目的：净吸水率可作为脑水肿的影像指标。我们的目的是研究净摄水量预测急性缺血性卒中和大血管闭塞患者90天功能预后的能力。 结论：Aspects净摄水量可以独立预测急性缺血性卒中和大血管闭塞患者90天的神经预后。将Aspects净摄水量与临床模型相结合可以提高结果分层的效率。

Lu SS, Wu RR, Cao YZ, et al. Automated Estimation of Quantitative Lesion Water Uptake as a Prognostic Biomarker for Patients with Ischemic Stroke and Large-Vessel Occlusion [published online ahead of print, 2022 Dec 22]. AJNR Am J Neuroradiol. 2022;10.3174/ajnr.A7741. doi:10.3174/ajnr.A7741 PMID: 36549850

Development of Gestational Age–Based Fetal Brain and Intracranial Volume Reference Norms Using Deep Learning

应用深度学习建立基于胎龄的胎脑和颅内体积参考值

We aimed to develop a deep learning algorithm for automatically measuring intracranial and brain volumes of fetal brain MRIs across gestational ages. Conclusions: Deep learning techniques can quickly and accurately quantify intracranial and brain volumes on clinical fetal brain MRIs and identify abnormal volumes on the basis of a normative reference standard.

我们的目标是开发一种深度学习算法，用于自动测量不同孕期的胎儿大脑磁共振成像的颅内和脑体积。 结论：深度学习技术可以在临床胎儿脑MRI上快速、准确地定量颅内和脑体积，并以标准化参考标准为基础识别异常体积。

Tran CBN, Nedelec P, Weiss DA, et al. Development of Gestational Age-Based Fetal Brain and Intracranial Volume Reference Norms Using Deep Learning [published online ahead of print, 2022 Dec 22]. AJNR Am J Neuroradiol. 2022;10.3174/ajnr.A7747. doi:10.3174/ajnr.A7747 PMID: 36549845