Cerebral amyloidoma: A mimicker of granulomatous disease on brain MRI Publication date: September 2019 Source: Journal of Neuroradiology, Volume 46, Issue 5 Author(s): Alireza Radmanesh, Matthew D. Wood, Andrew W. Bollen

Intracranial aneurysms treatment with Barricade coils: Safety and 1-year efficacy in a prospective, single-center series Publication date: September 2019 Source: Journal of Neuroradiology, Volume 46, Issue 5 Author(s): Raoul Guerreiro-Simoes, Sébastien Soize, Matthias Gawlitza, Pierre-François Manceau, Laurent Pierot Abstract Background and purpose Barricade coils (Blockade/Balt, Montmorency, France) are bare platinum coils, electrically detached existing in different shapes, softnesses, and sizes. This series is analyzing the safety (procedural complications) and efficacy (anatomical results at 1-year) of these coils in a prospective, single-center series. Materials and methods All patients with aneurysms treated with Barricade coils, without associated treatment (flow diverter, flow disrupter, or surgery) or parent artery occlusion were included. Peri-operative complications were evaluated. Anatomical results at 1-year were analyzed for patients that completed the 1-year digital subtraction angiographic follow-up and were independently evaluated by an expert neuroradiologist. Results During the study period (October 2013–October 2017), 132 patients (female: 88/132, 66.7%; median age: 50 years) with 141 aneurysms treated with Blockade coils were included. Aneurysm rupture, thromboembolic complication, and technical problems occurred in 9 aneurysms (6.3%), 8 aneurysms (5.6%), and 8 aneurysms (5.6%), respectively. Clinical consequences were variable; morbidity was reported in 5 patients (3.8%) and mortality in 2 patients (1.5%). Post-operatively aneurysm occlusion was complete in 117 aneurysms (83.0%), neck remnant in 16 aneurysms (11.3%), and aneurysm remnant in 8 aneurysms (5.7%). At 1-year aneurysm occlusion was complete in 53 aneurysms (51.5%), neck remnant in 34 aneurysms (33.0%), and aneurysm remnant in 16 aneurysms (15.5%). Retreatment in the year following the initial treatment was reported in 10 aneurysms (9.7%). Conclusion Treatment of ruptured, unruptured, and recanalized aneurysms with Barricade coils is associated with a good safety and 1-year efficacy.

Influence of vessel morphology and variations on technical and clinical success in mechanical thrombectomy: -In vivo and in vitro analyses- Publication date: September 2019 Source: Journal of Neuroradiology, Volume 46, Issue 5 Author(s): Silke Hopf-Jensen, Joana Marques, Stephanie Lehrke, Michael Preiß, Stefan Müller-Hülsbeck Abstract Purpose To determine the impact of vessel variation and anatomical features on technical and clinical success. Materials and methods In vitro blood clots (n = 100) were introduced into a silicon carotid-T flow model of 2, 3 or 4 mm. The ICA/M1 angle varied at 45°, 90°, 135° and 180°. Peripheral embolism was measured. In vivo 50 pat. (73.5 yrs., ± 15) with MCA occlusion were examined for siphon variation, ICA morphology, vessel diameter and angles. The patients were divided according to the clinical success (mRS): group A: mRS ≤ 2 after 90 day and group B: mRS ≥ 3. Furthermore the technical success (TICI) and number of retrieval (n) were analysed. Results In vitro with larger vessel diameter the migrated thrombus load decreased (P = .001). The steeper the M1/ICA angles, the higher thrombus weighs (180°: 2.94 mg; 135°: 6.32 mg; 90°: 8.65 mg, 45°: 10.69 mg; P < .001). In vivo patients with mRS ≤ 2 had significantly lower NIHSS (16.5 vs 20, P = .009) and higher ASPECTS (9 vs 6, P < .05). TICI ≥ 2b was more often achieved (86.6 vs 40% P = .002). The procedure time was lower (45 vs. 80 min, P < .05) with smaller number of retrieval (1.5 vs 4, P < 05). Proximal ICA stenosis offers a trend to unfavourable outcome (P = .073). Siphon variation “D” is associated with less retrieval manoeuvre. Conclusion While in vitro there is a close correlation between embolism and vascular anatomy, in vivo carotid artery stenosis and siphon variation influence clinical and technical success. Graphical abstract Data are shown as box plots (mean, ± SD). There is a strong correlation for an increasing risk of peripheral M1 embolism with smaller M1 vessel diameter and steeper ICA/M1 angel (figure 5a and b). In contrast, the thrombus weight in A1 decreased with smaller M1 vessel ID (figure 5c). On the other hand stepper ICA/M1 angel caused more embolism in the peripheral A1 segment (figure 5d). While in vitro there is a close correlation between embolism and vascular anatomy, in vivo carotid artery stenosis and siphon variation influence clinical and technical success.

MRI features of demyelinating disease associated with anti-MOG antibodies in adults Publication date: September 2019 Source: Journal of Neuroradiology, Volume 46, Issue 5 Author(s): Marc Denève, Damien Biotti, Sofia Patsoura, Marine Ferrier, Zuzana Meluchova, Laurence Mahieu, Françoise Heran, Catherine Vignal, Romain Deschamps, Olivier Gout, Nicolas Menjot de Champfleur, Xavier Ayrignac, Clarisse Carra Dallière, Pierre Labauge, Cécile Dulau, Thomas Tourdias, Hervé Dumas, Christophe Cognard, David Brassat, Fabrice Bonneville Abstract The spectrum of Myelin Oligodendrocytes Glycoprotein (MOG) antibody disease constitutes a recently described challenging entity, referring to a relatively new spectrum of autoimmune disorders with antibodies against MOG predominantly involving the optic nerve and spinal cord. The purpose of this article is to describe MRI features of MOG-AD involvement in the optic nerves, spinal cord and the brain of adults.

Quantitative analysis of cochlear signal intensity on three-dimensional and contrast-enhanced fluid-attenuated inversion recovery images in patients with Meniere's disease: Correlation with the pure tone audiometry test Publication date: September 2019 Source: Journal of Neuroradiology, Volume 46, Issue 5 Author(s): Jaehyung Lee, Eun Soo Kim, Yul Lee, Kwanseop Lee, Dae Young Yoon, Young-Su Ju, Hyo-Jeong Lee, Sung Kwang Hong, Mi Jung Kwon Abstracts Purpose The purpose of this study was to correlate the quantitative analysis of cochlear signal intensity (SI) on 3-dimensional fluid-attenuated inversion recovery (3D-FLAIR) and contrast-enhanced (CE) 3D-FLAIR images with results of the pure tone audiometry (PTA) test in patients with Meniere's disease (MD). Materials and methods Over a 3-year period, 123 patients with MD underwent 3-Tesla (3 T) temporal magnetic resonance imaging (MRI), including 3D-FLAIR and CE-FLAIR sequences. The SI of membranous labyrinth of the cochlea in both ears of each patient was measured by drawing a region of interest (ROI) with a seed growing technique. The correlation between measured cochlear SIs on 3D-FLAIR and CE-FLAIR images, contrast enhancement index (CEI), and contrast enhancement ratio (CER) and clinical findings and pre- and post-treatment PTA results were assessed. Results Cochlear signal ratios of symptomatic ears on 3D-FLAIR and CE-FLAIR images were significantly higher than those of asymptomatic ears (P < 0.001). The area under the curve, from the receiver operating characteristic curve of cochlear SIs on 3D-FLAIR and CE-FLAIR images for discrimination between symptomatic and asymptomatic ears, was 0.729 and 0.728, respectively. Cochlear SIs on 3D-FLAIR and CE-FLAIR images were significantly correlated with patients’ sex (P < 0.05 and P < 0.01, respectively), symptomatic ear (both P < 0.0001), and pre-treatment PTA (P < 0.0001 and P < 0.005, respectively), but were not significantly correlated with patients’ age, post-treatment PTA or hearing threshold level at 0.5, 1.0, 2.0, or 4.0 kHz. Conclusion Quantitative analysis of cochlear SI on 3D-FLAIR and CE-FLAIR images may be a helpful diagnostic adjunct for MD, but may be of little value in predicting the prognosis of MD.

The added prognostic value of magnetic resonance imaging in traumatic brain injury: The importance of traumatic axonal injury when performing ordinal logistic regression Publication date: September 2019 Source: Journal of Neuroradiology, Volume 46, Issue 5 Author(s): Marta Cicuendez, Ana Castaño-León, Ana Ramos, Amaya Hilario, Pedro A. Gómez, Alfonso Lagares Abstract Background and purpose This study was performed to investigate the prognostic value of traumatic axonal injury (TAI) in severe head trauma. Methods We attempted to determine whether any MR imaging findings of TAI could be related to prognosis in 264 patients with severe head trauma. We performed an ordinal logistic regression, adjusted for the prognostic factors according to the IMPACT studies, adding each MR feature related to prognosis one at a time. A new prognostic model was described by adding these MR features to the classic prognostic factors. The model was externally validated in a prospective series. Harrel's c-statistic and ordinal c-index (ORC) were calculated to measure its predictive accuracy. Results We found 178 patients with TAI lesions. Lesions in the basal ganglia/thalamus, corpus callosum (CC) and brain stem were associated with poor outcome (P < 0.01). The highest OR was for TAI lesions in the splenium (OR: 2.6) and brain stem dorsal lesions (OR: 3.1). We only found significant differences in outcome between haemorrhagic and non-haemorrhagic TAI lesions in the subgroup of patients with white matter and basal ganglia/thalamus lesions (P = 0.01). We obtained a superior discriminatory capacity by adding these MR findings to the previous prognostic model (Harrel's c-statistic 0.72 and ORC 0.7) in a prospective series of 93 patients. Conclusions The prognostic model including MR findings maintained a superior discriminatory capacity than that obtained for the model with the classic prognostic factors alone.

Diagnostic accuracy of flair in detection of acute subarachnoid hemorrhage in patients presenting with severe headache Publication date: September 2019 Source: Journal of Neuroradiology, Volume 46, Issue 5 Author(s): Rabia Ashraf, Muhammad Akhtar, Sohail Akhtar, Iqra Manzoor Abstract Background Fluid attenuation inversion recovery (FLAIR) magnetic resonance imaging (MRI) sequences are previously described for the evaluation of acute subarachnoid hemorrhage (SAH) and demonstrated good sensitivity. This study was designed to find the diagnostic accuracy of FLAIR in detection of acute SAH in patients presenting with severe headache considering the fact that controversy has been observed in previous studies. Objective To determine diagnostic accuracy of FLAIR in detection of acute subarachnoid hemorrhage in patients presenting with severe headache using lumber puncture as gold standard. Methodology A total of 245 patients fulfilling selection criteria were enrolled in the study through the emergency department of Combined Military Hospital, Lahore. MRI was performed by Philips Intera Achieva 1.5 T super conducting MR unit (Philips Medical Systems, the Netherlands), with the use of a head coil. FLAIR examination was performed at 6700/150 (TR/TE) with an inversion time (TI) of 2200 ms, a field of view 230 mm, matrix 189 × 256, scan time of 3 min 50s and section thickness 5 mm in axial plane. Following MRI, patients underwent lumbar puncture for cerebrospinal fluid (CSF) examination after 8–12 h from the onset of event. MRI and CSF analysis results were then compared. Results Out of 245 cases, 49.39% (n = 121) were between 20–55 years of age while 50.61% (n = 124) were between 56–70 years of age, mean ± sd was calculated as 52.13 ± 10.45 years, 53.88% (n = 132) were male while 46.12% (n = 113) were females, frequency of acute subarachnoid hemorrhage in patients presenting with severe headache was recorded as 5.71%(n = 14), diagnostic accuracy of FLAIR in detection of acute subarachnoid hemorrhage in patients presenting with severe headache taking lumbar puncture as gold standard as 78.57% sensitivity, 96.53% specificity, 57.89% positive predictive value, 98.67% negative predictive value and accuracy rate was calculated as 95.29%. Conclusion Diagnostic accuracy of FLAIR in detection of acute subarachnoid hemorrhage in patients presenting with severe headache taking lumbar puncture as gold standard is higher and reliable.

Comparison of automated and visual DWI ASPECTS in acute ischemic stroke Publication date: September 2019 Source: Journal of Neuroradiology, Volume 46, Issue 5 Author(s): E. Kellner, M. Reisert, V.G. Kiselev, C.J. Maurer, H. Urbach, K. Egger Abstract Background and purpose To assess intra-and inter-rater agreement of the ASPECTS (Alberta Stroke Program Early CT Score) based on diffusion-weighted MRI and to compare it with fully – automated methods (eASPECTS). Methods DWI-ASPECTS of scans of 96 patients with acute ischemic stroke was rated by 2 experts. Automated methods based on thresholding the affected volumes of a coregistered atlas, and a regression tree learning method were established. Intra-rater, inter-rater and human-rater vs. automated methods agreements were investigated based on the intraclass correlation coefficients (ICC) and Bland Altman plots. Results Intra-rater agreement was good for both raters (ICC of 0.91 and 0.93). Inter-rater agreement was worse (ICC = 0.86) indicating a slight bias between both raters. Agreement with automated methods ranged from 0.81 to 0.87. Root-mean-squared deviation was 0.89 and 0.69 for the human raters and ranged from 0.95 to 1.24 for the automated methods. Conclusions Agreement values are on the same order or higher compared to a literature review of CT-based ASPECTS. Automated methods perform slightly worse than human expert ratings, but they still have enough power to determine the DWI-ASPECTS with good precision in a clinical setting.

Presurgical differentiation between malignant haemangiopericytoma and angiomatous meningioma by a radiomics approach based on texture analysis Publication date: September 2019 Source: Journal of Neuroradiology, Volume 46, Issue 5 Author(s): Xuanxuan Li, Yiping Lu, Ji Xiong, Dongdong Wang, Dejun She, Xinping Kuai, Daoying Geng, Bo Yin Abstract Purpose To assess whether a machine-learning model based on texture analysis (TA) could yield a more accurate diagnosis in differentiating malignant haemangiopericytoma (HPC) from angiomatous meningioma (AM). Materials and methods Sixty-seven pathologically confirmed cases, including 24 malignant HPCs and 43 AMs between May 2013 and September 2017 were retrospectively reviewed. In each case, 498 radiomic features, including 12 clinical features and 486 texture features from MRI sequences (T2-FLAIR, DWI and enhanced T1WI), were extracted. Three neuroradiologists independently made diagnoses by vision. Four Support Vector Machine (SVM) classifiers were built, one based on clinical features and three based on texture features from three MRI sequences after feature selection. The diagnostic abilities of these classifiers and three neuroradiologists were evaluated by receiver operating characteristic (ROC) analysis. Results Malignant HPCs were found to have larger sizes, slighter degrees of peritumoural oedema compared with AMs (P < 0.05), and more serpentine-like vessels. The AUC of the enhanced T1WI-based classifier was 0.90, significantly higher than that of T2-FLAIR-based or DWI-based classifiers (0.77 and 0.73). The AUC of the SVM classifier based on clinical features was 0.66, slightly but not significantly lower than the performances of 3 neuroradiologists (AUC = 0.69, 0.70 and 0.73). Conclusion Machine-learning models based on clinical features alone could not provide a better diagnostic performance than that of radiologists. The SVM classifier built by texture features extracted from enhanced T1WI is a promising tool to differentiate malignant HPC from AM before surgery. Graphical abstract

Artificial neuroradiology: Between human and artificial networks of neurons? Publication date: September 2019 Source: Journal of Neuroradiology, Volume 46, Issue 5 Author(s): Arnaud Attyé, Julien Ognard, François Rousseau, Douraied Ben Salem