Survivors of immune thrombotic thrombocytopenic purpura (iTTP) face an increased risk of cerebrovascular disease, including silent cerebral infarction (SCI), cognitive impairment, and stroke. The prospective Neurologic Sequelae of iTTP study evaluated the natural history of SCI (by brain magnetic resonance imaging) during clinical remission and its association with stroke risk and cognitive impairment, measured by the National Institutes of Health Toolbox cognition battery. SCI burden was quantified using the modified age-related white matter changes (ARWMC) score. Among 42 patients who completed the baseline study visit, 28 completed a second assessment at a median interval of 12.5 months. New or progressive SCI were observed in 8 of 28 patients (28.6%), with the median ARWMC score increasing from 4 to 5 (P = .002). SCI progression was associated with a higher baseline ARWMC score (median, 7 vs 1; P = .011) but not with age, hypertension, diabetes, or average remission ADAMTS13 activity. Over a median follow-up of 32 months, 6 of 42 participants (14.3%) developed stroke, with significantly higher stroke risk among those with a higher baseline ARWMC score (hazard ratio, 1.36; 95% confidence interval, 1.01-1.83; P = .043). Cognitive function significantly improved in patients without SCI progression but not in those with progressive SCI. In summary, SCI is progressive during clinical remission in iTTP and associated with an increased risk of stroke and persistent cognitive impairment. SCI burden and progression may serve as shorter-term end points for clinical trials aimed at mitigating stroke risk and improving cognitive outcomes after iTTP.

Beyond patient history, clinical examination and psychophysical gustatory testing, no standardized guidelines exist for the diagnosis of unclear taste disorders, especially regarding imaging. We therefore aimed to investigate the frequency of use of magnetic resonance imaging (MRI), the findings, and the cost and benefits in a large cohort of patients with taste disorders presenting at a tertiary referral centre over a period of 10 years. We retrospectively reviewed clinical records of all patients with gustatory disorders presenting at our tertiary smell and taste clinic between 2010 and 2019 who received an MRI. A board-certified neuroradiologist, specialized in head and neck imaging, reviewed all MRIs. MRI findings were classified according to their relevance to the taste disorder. A cost-benefit analysis was performed. Of the 125 patients with taste complaints, 70 underwent MRI. Imaging data were retrievable for 65 patients, representing 52% of the total cohort. Pathological findings were observed in 54 patients; 46 had incidentalomas not related to the initial complaint. Findings potentially related to the gustatory complaint (treatable in 6 cases, not treatable in 2 cases) were seen in only 8 MR scans. The imaging findings matched the clinical findings in only 4 cases, and these were therefore classified as clearly related to the complaint. The total cost of all the MRIs performed was 55,034.89 CHF. The estimated costs per finding attributable to a taste disorder were 13,758.72 CHF. In this selected cohort of patients with isolated taste disorders, MRI rarely revealed findings clearly attributable to the complaint. While incidentalomas were frequent, clinically relevant abnormalities were uncommon. These results suggest that MRI should be reserved for select cases, and its routine use critically evaluated. Further prospective studies are needed to better define when MRI is warranted in the diagnosis of unclear isolated taste disorders.

Although Magnetic Resonance Imaging (MRI) is gaining momentum in forensic and post-mortem settings, its exact role in forensic investigations is yet to be determined. The current review aims to chart current and potential roles of MRI in forensic investigations, providing an overview of existing pertinent scientific literature. A mapping review was conducted in accordance with the PRISMA guidelines. Medline, Web of Science, Embase and the Cochrane Library were searched using database-specific syntaxes. Eligible articles included reviews, original research, case reports, letters, laboratory studies, and dissertations written in English. Articles not mentioning MRI, involving only functional MRI, and non-forensic clinical post-mortem examinations were excluded. Articles were categorised using thematic analysis. Data extraction included first-author country of origin, year of publication, level of evidence, and mention of MRI-protocol. The initial search yielded 16,184 papers, 525 of which were included. Main focus of forensic MRI research is in medicolegal examination (n = 285), identification (n = 158), and process optimisation (n = 155); 73 articles were multi-categorical, and myriad subcategories were identified (foetus/child/adult, living/postmortem, anatomical regions, practice/guidelines/infrastructure, etc.). Articles were published over a 34-year period, originating from 34 countries. There were 235 level C-, 289 level B-, and 2 level A-evidence articles. 268 articles mentioned MRI protocols. The extensive amount of research across myriad subcategories highlights vast potential of MRI in forensic investigation. However, the overall level of evidence at this time is low, lacking standardisation. Further organization, standardization, and high-quality research are needed to clarify how best to apply MRI in forensic settings.

This study aimed to investigate the frequency of labral tears (LT) using 3.0-Tesla magnetic resonance imaging (MRI) among different age groups of Japanese patients with or without acetabular dysplasia. This was a retrospective study including 481 Japanese patients with hip pain. These patients were divided into two groups according to the degree of acetabular coverage: dysplasia (n = 256) and nondysplasia (n = 225) groups, respectively. LT were observed in 341 (71%) patients with pre- or early-stage OA and hip pain on MRI. A multivariable logistic regression analysis revealed that the risk of labrum tears increased with age (odds ratio [OR] = 1.04; 95% confidence interval [CI] = 1.03-1.06; p < 0.001) and acetabular dysplasia (OR = 1.80; 95% CI = 1.15-2.82; p = 0.0096). Patients in their twenties in the dysplasia group showed a significantly higher rate of LT than those in the nondysplasia group (74% vs. 38%, p = 0.029). A high rate of LT was observed in Japanese patients with pre- or early-stage OA and hip pain regardless of the degree of acetabular coverage. Patients in their twenties with dysplasia showed a significantly higher rate of LT than those without dysplasia.

Neurolymphomatosis (NL) is a rare manifestation of lymphoma resulting from the infiltration of malignant lymphoma cells into the peripheral nervous system. When evaluating peripheral neuropathy, clinical suspicion of NL is highly necessary because its clinical symptoms vary and pathological diagnosis is often difficult. Imaging modalities carry a high sensitivity to diagnose NL. 18F-flurodeoxyglucose positron emission tomography-computed tomography (18F-FDG PET/CT), with a diagnostic sensitivity of over 90%, as well as Magnetic resonance imaging (MRI) neurography, has become the leading diagnostic modalities for NL diagnosis, staging, and treatment response assessment. At present, the prognosis of NL is usually poor, and its treatment is also challenging, with few patients benefiting from the currently available treatment measures. The present report discusses two cases of diffuse large B-cell lymphoma-associated NL. They presented with painful polyneuropathy/polyradiculopathy, and imaging examinations such as MRI and 18F-FDG PET/CT indicated related neuropathy. Both cases were treated with PR2-based immunotherapy (anti-PD-1 tirelizumab 200mg d1, rituximab 375 mg/m2 d0, and lenalidomide 25mg d1-14). And clinical efficacy was observed, with improved symptoms. Imaging studies showed a significant reduction in lesions of the cervical plexus nerve roots, lumbosacral nerve, sciatic nerve, and brachial plexus. In this study, the two cases of NL with typical clinical and imaging manifestations discussed in the present report exhibited good clinical efficacy after receiving PR2-based immunotherapy. These results provide insights into the development of a novel, potentially effective treatment option for patients with NL.

Desmoid tumors (DTs) are rare, locally aggressive soft tissue neoplasms with highly variable clinical behavior. Although benign, their infiltrative nature can lead to considerable morbidity. DTs present a major challenge due to their unpredictable behavior and potential for misdiagnosis. Recently, there has been a large shift in the treatment strategy for DTs, and the number of cases being followed up with imaging has increased. Cryoablation has emerged as a minimally invasive treatment option, yet post-procedural imaging features remain poorly characterized. This study illustrates the magnetic resonance imaging (MRI) evolution of DTs following percutaneous cryoablation, emphasizing key patterns across pre-treatment, intra-procedural, and follow-up studies. The available MRI follow-up ranged from 6 to 30 months. Through a pictorial approach, we aimed to provide radiologists with practical insights to avoid misinterpretation of expected post-treatment changes as recurrence and to improve clinical management.

To compare the safety and diagnostic yield of two ultrasound (US)-guided percutaneous renal biopsy (PRB) approaches, lateral to medial and medial to lateral, which differ in access route, muscle groups traversed, and cortical targets. This retrospective study included 490 patients (mean age: 38.2 ± 21.2 years; 267 men, 223 women) who underwent US-guided PRB between 2019 and 2024 and had abdominal computed tomography (CT)/magnetic resonance imaging (MRI) within 1 year. At the left kidney lower pole level (L3-L4), anterior-posterior thicknesses of the traversed muscle groups were measured on CT/MRI. Complications were classified according to the Society of Interventional Radiology guidelines. Diagnostic yield was categorized as optimal (≥ 12 glomeruli), suboptimal (≥ 3 glomeruli), and pathologist based (diagnostic according to final pathology assessment). Group comparisons were performed using the chi-square test, Fisher's exact test, and t-test. In 490 PRBs (237 lateral to medial, 253 medial to lateral), the medial-to-lateral approach, despite traversing thicker muscles (35.7 vs. 11.5 mm, P = 0.001), produced smaller hematomas (8.6 vs. 17.3 mm, P = 0.001) with similar complication rates (major: 3.6% vs. 3.4%, P = 0.913; minor: 36% vs. 33.8%, P = 0.608). Diagnostic adequacy was comparable, but optimal yield was higher with the medial-to-lateral route (85.0% vs. 73.0%, P = 0.001). Both approaches demonstrated comparable safety. However, the medial-to-lateral route was associated with smaller hematomas and a higher proportion of optimal biopsies from the lateral cortex, but suboptimal and pathologist-based adequacy remained high in both techniques. When standard lower pole lateral cortex biopsy is not feasible due to cortical scarring, cysts, overlying skin lesions, or anatomic limitations-especially in patients for whom contralateral biopsy is not possible (e.g., solitary or ectopic pelvic kidney, severe unilateral hydronephrosis)-alternative cortical targets must be used. Understanding how different access routes and muscle pathways influence hemorrhage control and diagnostic yield helps operators choose the safest and most effective technique in these situations.

Neurocysticercosis (NCC), a parasitic infection of the central nervous system caused by Taenia solium larvae, is a leading cause of acquired epilepsy in endemic regions. This case describes a 40-year-old male who presented with chronic headache, dizziness, and a recent seizure episode. He had no prior history of systemic illness, tuberculosis, or neurological disorders. Magnetic Resonance Imaging (MRI) of the brain revealed multiple ring-enhancing lesions with an eccentric scolex in the cerebral and cerebellar hemispheres, accompanied by surrounding edema, confirming the diagnosis of neurocysticercosis. Additional lesions in extraocular, facial, and tongue muscles were consistent with myocysticercosis, an uncommon but clinically significant manifestation that may mimic inflammatory or neoplastic processes.Spinal imaging demonstrated degenerative changes, including diffuse cervical disc bulges at multiple levels (C3–C7) and lumbar disc pathology at L4–L5, causing anterior thecal sac indentation but without cord compression or myelomalacia. While the spinal findings were incidental, they were clinically relevant as contributors to chronic pain and potential neurological deficits.The coexistence of disseminated neurocysticercosis with muscular involvement and early degenerative spinal disease highlights the importance of comprehensive evaluation in patients presenting with seizures and persistent headache. Treatment included albendazole-based antiparasitic therapy, corticosteroids to reduce perilesional edema, antiepileptic medications, and conservative management for disc disease.This case underscores the role of MRI in identifying pathognomonic features of cysticercosis, emphasizes the need for systemic evaluation, and demonstrates the significance of recognizing coexisting pathologies for tailored multidisciplinary management.

This prospective multicenter study aimed to evaluate the applicability and feasibility of the updated International League Against Epilepsy (ILAE) seizure classification (basic version) in secondary referral centers, using information from history-taking and basic investigations (routine or sleep electroencephalography, and computed tomography or magnetic resonance imaging when indicated). The primary outcome was the proportion of patients whose seizures could be classified. Secondary outcomes addressed the new elements introduced in the updated classification: ictal responsiveness and recall (awareness) for classifying the state of consciousness, and the basic seizure descriptors (with vs. without observable manifestations). Data from 458 consecutive patients (152 pediatric) across seven outpatient epilepsy clinics were analyzed. All seizures could be classified according to the basic version of the updated ILAE seizure classification. Information on awareness was available in 396 patients (86.5%) and on responsiveness in 380 (83.0%). In 11 patients (2.4%), the ictal state of consciousness could not be determined. Information on basic seizure descriptors was available for 452 patients (98.7%). These findings indicate that the basic version of the updated ILAE seizure classification is feasible and applicable at secondary referral centers. Moreover, state of consciousness and basic seizure descriptors can be inferred from history in nearly all patients.

Neuronal intranuclear inclusion disease (NIID) is a highly heterogeneous chronic neurodegenerative disease characterized by ataxia, extrapyramidal symptoms, peripheral neuropathy, autonomic nervous symptoms, and cognitive dysfunction. So far, recurrent dizziness and headache have been reported in cases of NIID. We report a case of a 71-year-old female patient with NIID, who was followed up for 5 years. The primary manifestations in this patient were episodic dizziness and headache, which are relatively nonspecific symptoms. Due to these characteristics, it is easy to misdiagnose or overlook the disease at the initial diagnosis. The patient exhibited characteristic high signal intensity at the corticomedullary junction on diffusion-weighted imaging (DWI) sequences of the head magnetic resonance imaging (MRI). We diagnosed NIID after detecting round, non-enveloped filamentous structures with a diameter of 1–2 μm within the nuclei of fibroblasts and Schwann cells and revealing 114 repeats of GGC amplification at the 5′end of the NOTCH2NLC gene. The findings of this case study indicate that patients presenting with atypical symptoms should be considered for this disease.

Alterations in brain structure following adversity show inconsistencies. Jointly considering maltreatment exposure alongside externalizing psychopathology may therefore prove helpful. However, few prospective studies currently follow up maltreated youth with high or low externalizing problems using neuroimaging assessments. A structural magnetic resonance imaging study was conducted using T1-weighted scans from 98 youth (MAge = 14.76, SDAge = 1.96; 51% girls) comparing participants with low (n = 29) and high (n = 29) maltreatment exposure to carefully matched non-maltreated controls (n = 40). Comprehensive assessments of maltreatment history and psychopathology were ascertained across two waves, applying the Maltreatment Classification System alongside caregiver- and teacher-reported externalizing problems. Neuroimaging was conducted at the second wave. We found dose-dependent amygdala volume reductions following maltreatment and particularly abuse exposure, primarily driven by the basolateral subregion. Interaction analyses revealed lower amygdalar and hippocampal volumes in youth exposed to more vs. less extensive maltreatment, but merely among those with elevated externalizing problems. These findings highlight the value of the ecophenotype model for elucidating neural correlates of maltreatment and its sequelae.

In the assessment of cerebrospinal fluid flow disorders such as aqueductal stenosis, Chiari malformation, and post-operative complications, conventional imaging often falls short in resolving subtle anatomical and dynamic nuances. This case series explores the value of integrating high-resolution flow-sensitive and flow-compensated magnetic resonance imaging sequences to enhance diagnostic precision in challenging scenarios. Across five diverse cases, the combined approach revealed subtle aetiologies like prepontine adhesions, fourth ventricle outlet obstruction, aqueductal stenosis and minute dural breaches - all which were undetectable with routine conventional imaging.

The need for simple, non-invasive biomarkers for prostate cancer (PCa) diagnosis is increasing. Urinary PSA (uPSA) and Zinc (uZinc) are emerging as potential PCa risk indicators. This study aimed to develop a rapid urine test combining uPSA and uZinc, assessing its diagnostic value alone and with Standard of Care (SOC) parameters, including age, serum PSA, DRE, and multiparametric Magnetic Resonance Imaging (mpMRI). We enrolled 260 men undergoing prostate biopsy. Post-massage urine samples were analyzed using a rapid urine test combining lateral flow immunoassay (uPSA) and colorimetric dipstick assay (uZinc) with confirmatory testing via ELISA and colorimetric in vitro assay. Logistic regression models (SOC, uPSA, uZinc, Urine test [uPSA + uZinc], SOC + Urine test) and mpMRI models were tested. Diagnostic accuracy was evaluated using AUCs from ROC analysis. A decision-making algorithm targeting patients with increased PSA up to 10 ng/mL, negative DRE, and PIRADS ≤ 3 was proposed to assess the number of unnecessary biopsies potentially avoided with the urine test. Among 242 evaluable patients, 146 (59%) had PCa. The rapid Urine test provided intensity scores inversely proportional to biomarker concentration. uPSA strongly correlated with clinical stage, D'Amico risk, and Gleason score, while uZinc showed a weaker trend. The Urine test reached an AUC of 0.769, which improved performance to 0.789 with SOC + Urine test (p = 0.0002). Combining urine markers with mpMRI yielded AUCs of 0.868 (mpMRI+Urine test) and 0.875 (mpMRI+SOC+Urine test; p < 0.0001). The decision-making algorithm integrating urine test demonstrated that 51% of men could safely avoid biopsy, with a 13% detection rate of only low-grade PCas (ISUP < 2) in this group. This uPSA/uZinc urine test is a promising adjunct to current diagnostic pathways, improving accuracy in detecting clinically significant PCa while reducing unnecessary biopsies. Its integration with mpMRI and SOC parameters could refine risk assessment and personalize patient management.

Background and Clinical Significance: Tyrosine kinase inhibitors (TKIs) have transformed Philadelphia chromosome-positive chronic myeloid leukemia (Ph+ CML) into a largely manageable chronic disease. However, off-target toxicities are increasingly recognized; rarer complications such as bone marrow edema (BME) remain underreported. BME is a radiological syndrome characterized by excess intramedullary fluid on fat-suppressed T2/STIR magnetic resonance imaging sequences and may progress to irreversible osteochondral damage if unrecognized. We report a case series of TKI-associated BME and propose a practical diagnostic-therapeutic framework. Case Presentation: We describe three patients with Ph+ CML who developed acute, MRI-confirmed BME of the lower limb during TKI therapy. Case 1 developed unilateral then bilateral knee BME, temporally associated first with dasatinib and subsequently with imatinib; symptoms improved after TKI interruption, bisphosphonate therapy, and supportive measures, and did not recur after switching to bosutinib. Case 2 presented with proximal femoral BME during long-term imatinib; imatinib was stopped, intravenous neridronate administered, and bosutinib initiated with clinical recovery and later near-complete radiological resolution. Case 3 experienced multifocal foot and ankle BME during imatinib; symptoms resolved after drug discontinuation and bisphosphonate therapy, and disease control was re-established with bosutinib without recurrence of BME. All patients underwent molecular monitoring and mutational analysis to guide safe therapeutic switching. Discussion: Temporal association across cases and the differential kinase profiles of implicated drugs suggest PDGFR (and to a lesser extent, c-KIT) inhibition as a plausible mechanistic driver of TKI-associated BME. PDGFR-β blockade may impair pericyte-mediated microvascular integrity, increase interstitial fluid extravasation, and alter osteoblast/osteoclast coupling, promoting intramedullary edema. Management combining MRI confirmation, temporary TKI suspension, bone-directed therapy (bisphosphonates, vitamin D/calcium), symptomatic care, and, when required, therapeutic switching to a PDGFR-sparing agent (bosutinib) led to clinical recovery and preservation of leukemia control in our series. Conclusions: BME is an underrecognized, potentially disabling, TKI-related adverse event in CML. Prompt recognition with targeted MRI and a multidisciplinary, stepwise approach that includes temporary TKI adjustment, bone-directed therapy, and consideration of PDGFR-sparing alternatives can mitigate morbidity while maintaining disease control. Prospective studies are needed to define incidence, risk factors, optimal prevention, and management strategies.

We present a rare case of a large fetal oropharyngeal teratoma (epignathus) diagnosed during the third trimester and managed successfully with a planned ex utero intrapartum treatment (EXIT) procedure followed by neonatal surgical resection. A 30-year-old pregnant woman was referred to our department at 29 weeks of gestation due to polyhydramnios and the detection of an oropharyngeal mass on ultrasound. Fetal magnetic resonance imaging confirmed a 5×5 cm heterogeneous mass filling the oral cavity, raising concern for airway obstruction at birth. At 32 weeks, spontaneous pre-term labor necessitated urgent EXIT. While fetoplacental circulation was maintained, a tracheostomy was performed to secure the airway, allowing for safe delivery and ventilation of the neonate. The newborn subsequently underwent successful transoral surgical excision of the mass, which was confirmed histologically as an immature teratoma. Postoperative recovery was uneventful, and the infant remained free of recurrence during a 24-month follow-up period. This case highlights the importance of prenatal diagnosis, fetal imaging, and multidisciplinary planning in the management of airway-compromising lesions. It also introduces the EXIT procedure to otolaryngologists as a critical and effective approach for ensuring airway patency in selected high-risk cases of congenital head and neck tumors.

Shared neural network dysfunctions in treatment-resistant major depression and alcohol use disorder: Resting-state fMRI evidence and implications for neuromodulation.

Although the benefit of nerve-sparing surgery for deep endometriosis (DE) with postoperative voiding dysfunction has been demonstrated, it requires a high level of surgical skill to accurately remove endometriosis lesions while preserving autonomic nerves in situations of severe adhesions and fibrosis and has been performed only by expert surgeons. However, endometriosis is a common disease, and methods for intraoperative identification of endometriosis lesions, ureters, vessels, and nerves using near-infrared imaging with indocyanine green (ICG) have been explored to enable more surgeons to safely offer such procedures to their patients. To demonstrate the step-by-step technique of single-port robotic nerve-sparing DE surgery with ICG navigation. The patient was a 48-year-old woman with chronic pelvic pain. Magnetic resonance imaging revealed uterine adenomyosis and a right ovarian endometrioma with DE involving the uterosacral ligament and surface of the rectum. An intravenous injection of 0.25 mg/kg body weight of ICG for intraoperative near-infrared fluorescence (NIR) imaging with the da Vinci SP. The use of ICG with NIR during nerve-sparing DE surgery may improve the surgeon's decision-making process. ICG may be useful in highlighting pelvic autonomic nerves, identifying DE lesions, checking for pelvic organ injury, and assessing tissue perfusion and haemostasis. However, further research is needed to confirm the possible role of ICG in this setting. This video illustrates the potential of ICG fluorescence to enhance intraoperative visualisation of autonomic nerves and DE lesions, offering educational insights into safer and more widely accessible advanced surgical techniques.

Objective: To investigate the clinical, imaging and neuropathological characteristics of neuronal intranuclear inclusion disease (NIID) with symptoms of the central nervous system, and to improve the diagnosis and treatments of NIID. Methods: The clinical data of 7 patients with NIID diagnosed by brain biopsy in Xuanwu Hospital, Capital Medical University, Beijing, China from February 2009 to December 2024 were collected. The characteristics of clinical manifestations, imaging, and histology on brain biopsy were retrospectively analyzed. Results: Among the 7 patients, 5 were male and 2 were female. Their ages ranged from 44 to 70 years, median 56 (52, 65) years. Patients were classified into three types of tumor, stroke and encephalitis according to the onset symptoms, imaging manifestations and pathological changes. The chief complaint of the 5 patients was headache, while 4 patients had paroxysmal convulsions, 3 had speech disorders, 2 had abnormal mental behaviors, 2 had memory decline, and 1 had fever accompanied by consciousness disorders. Diffusion-weighted magnetic resonance imaging of the head showed the "ribbon sign" at the junction of the cortex and medulla in 2 cases. Most of the patients had white matter lesions, gyrus swelling and cerebral atrophy. Occasionally gyrus-like enhancement was observed. Brain biopsy reveals the histological changes that matched those on images and initial symptoms. There were proliferation of oligodendrocytes and astrocytes in the white matter, leukoaraiosis and edema, cortical disintegration and lamellar necrosis, as well as infiltration of lymphocytes and microglia, etc. However, the characteristic changes were eosinophilic hyaline inclusions in the nuclei of neurons and astrocytes. Immunohistochemical staining of p62 and ubiquitin showed homogeneous staining in round or ring-shaped nuclei. Conclusions: The clinical manifestations of NIID are highly variable, and a correct diagnosis of NIID requires careful integration of clinical, imaging and histopathologic data. For patients with a high suspicion of NIID, immunohistochemical staining of p62 and ubiquitin is diagnostically valuable.

We investigated the association between middle cerebral artery atherosclerotic plaque features and cerebral small vessel disease (CSVD) imaging markers as well as the total CSVD burden, in patients with branch atheromatous disease (BAD). Plaque parameters were quantified using high-resolution magnetic resonance imaging (HR-MRI) with ImageJ software, to characterize distribution, lumen stenosis, remodeling patterns, and other relevant features. Conventional MRI assessed CSVD imaging markers and total CSVD burden. Multivariate logistic regression analysis was performed following adjustment for potential confounders. Receiver operating characteristic (ROC) curve analysis with the DeLong test assessed the predictive value of plaque features for total CSVD burden. Compared with the non-plaque group, the plaque group showed significantly higher proportions of severe white matter hyperintensities (WMHs), cerebral microbleeds (CMBs), and moderate-to-severe CSVD burden (p < 0.05). In multivariate analysis, the presence of plaque was an independent risk factor for WMHs (OR = 2.920), CMBs (OR = 1.995), and moderate-to-severe CSVD burden (OR = 2.853); plaque distribution was an independent risk factor for WMHs (OR = 3.367); eccentric plaques were independent risk factors for lacunar infarction (OR = 8.670) and CMBs (OR = 7.891); positive remodeling (OR = 9.285) and eccentric plaques (OR = 10.355) were independent risk factors for moderate-to-severe CSVD burden. ROC analysis demonstrated plaque vulnerability effectively predicted moderate-to-severe CSVD burden (AUC = 0.8808, p < 0.05). In ischemic stroke patients, distinct intracranial atherosclerotic stenosis (ICAS) plaque features correlate with specific CSVD phenotypes. Vulnerable plaques not only significantly increase total CSVD burden but also effectively predict CSVD severity. These findings elucidate how ICAS influences CSVD burden progression from an HR-MRI perspective and facilitate clinical risk stratification.

Multiple sclerosis (MS), one of the most common neurological causes of disability in young adults, is characterized by cognitive deficits in addition to balance-related symptoms, fatigue, and visual symptoms. Patients have difficulties in different cognitive domains such as memory, learning, executive functions, and attention, especially information processing speed. Current conventional imaging methods are insufficient to elucidate cognitive impairments. Structural alterations in the brain obtained by magnetic resonance imaging (MRI) do not have a high correlation in explaining all cognitive deficits. Therefore, connectivity-based approaches that address brain functions in a more holistic perspective come to the forefront in explaining cognitive functions. The relationship of cognitive deficits with large-scale functional networks through functional connectivity-based approaches via resting-state functional magnetic resonance imaging has begun to be investigated. Although functional connectivity (FC) studies are successful in explaining cognitive functions, the findings are not homogenous. The aim of this review is to analyse the contribution of functional connectivity-based approaches in understanding the clinical-imaging mismatch and to show that cognitive dysfunctions frequently seen in MS patients can only be partially explained by conventional structural imaging techniques. In this respect, this study is a narrative review based on a review of the literature published in the last fifteen years. While the importance of FC in explaining cognitive functions is mentioned, it is also emphasized that the findings of this study may be affected by individual factors such as cognitive reserve.