Magnetic Resonance Imaging Angiography Research Articles

Retrospective Case Series of Vertebral Artery Injuries Associated with Cervical Spine Trauma

BackgroundVertebral artery injuries (VAI) can occur due to cervical spine trauma. VAI can prove a serious complication and potentially compromise vascular supply to the posterior aspect of the brain. Currently, there is a paucity of evidence with regards to incidence, management, and outcomes for these patients. The purpose of this study is to investigate and elucidate the incidence of VAI associated with cervical trauma at a national tertiary referral centre for spinal pathology, their respective management, and associated outcomes. MethodsA retrospective review was conducted from 2012-2021 to identify patients with VAI secondary to cervical spine trauma. Demographic, clinical, and radiological data was collected to identify common traits in injury characteristics and management. Results1013 spine patients presented to our institution across the 10-year period. 739/1013 (72.9%) were trauma patients. 42/739 (5.7%) were imaged for suspected VAI secondary to trauma. There were 14/739 (1.9%) confirmed VAI. All patients had CT-angiography for diagnosis. Four of the confirmed VAI patients (28.6%) had additional MR-angiography imaging. Right-side was the most common side of VAI injury (7/14; 50%), followed by left (5/14; 35.7%) and bilateral (2/14; 14.3%) injuries. 8/14 (57.1%) patients were prescribed anti-thrombotic therapy. Acute mortality within 3-months was noted to be 2/14 (14.3%) and occurred at 49 days and 57 days respectively. ConclusionVAI associated with cervical spine injury is rare in occurrence. However, it can be associated with high morbidity and mortality. As such, a multi-disciplinary approach to care is integral to ensuring good outcomes in these patients.

3D Transcranial ultrasound localization microscopy reveals major arteries in the sheep brain.

Cerebral circulation ensures the proper functioning of the entire human body, and its interruption, i.e. stroke, leads to irreversible damage. However, tools for observing cerebral circulation are still lacking. Although MRI and CT scans serve as conventional methods, their accessibility remains a challenge, prompting exploration into alternative, portable, and non-ionizing imaging solutions like ultrasound with reduced costs. While Ultrasound Localization Microscopy (ULM) displays potential in high-resolution vessel imaging, its 2D constraints limit its emergency utility. This study delves into the feasibility of 3D ULM with multiplexed probe for transcranial vessel imaging in sheep brains, emulating human skull characteristics. Three sheep underwent 3D ULM imaging, compared with angiographic MRI, while skull characterization was conducted in vivo using ultrashort bone MRI sequences and ex vivo via micro CT. The study showcased 3D ULM's ability to highlight vessels, down to the Circle of Willis, yet within a confined 3D field-of-view. Future enhancements in signal, aberration correction, and human trials hold promise for a portable, volumetric, transcranial ultrasound angiography system.

Investigation of distributed learning for automated lesion detection in head MR images.

In this study, we investigated the application of distributed learning, including federated learning and cyclical weight transfer, in the development of computer-aided detection (CADe) software for (1) cerebral aneurysm detection in magnetic resonance (MR) angiography images and (2) brain metastasis detection in brain contrast-enhanced MR images. We used datasets collected from various institutions, scanner vendors, and magnetic field strengths for each target CADe software. We compared the performance of multiple strategies, including a centralized strategy, in which software development is conducted at a development institution after collecting de-identified data from multiple institutions. Our results showed that the performance of CADe software trained through distributed learning was equal to or better than that trained through the centralized strategy. However, the distributed learning strategies that achieved the highest performance depend on the target CADe software. Hence, distributed learning can become one of the strategies for CADe software development using data collected from multiple institutions.

Neglected Superior Ophthalmic Vein Enlargement before Delayed Symptom of Carotid-Cavernous Fistula in a Blowout Fracture: A Case Report and Literature Review.

Carotid-cavernous fistula (CCF) is a rare condition. However, it should be suspected when there are traumatic facial fractures, because if not diagnosed, it can lead to permanent damage such as blindness. Traumatic CCF often presents delayed symptoms, and delayed diagnosis without prompt treatment can lead to permanent injuries in optic and cranial nerves III, IV, V, and VI as well as intracranial hemorrhage. The routine initial modality for patients with suspected facial bone fractures is noncontrast computed tomography (CT) to identify any fracture lines and check for intracranial hemorrhage. We report a post-traumatic CCF case with a 4-day symptom delay, where left superior ophthalmic vein (SOV) enlargement was observed on the routine noncontrast facial CT with ipsilateral orbital wall fracture. When the patient first presented to the emergency room (ER), we did not detect vein enlargement on CT. Afterwards, the patient developed delayed symptoms of CCF and was readmitted to the ER. When we reanalyzed the first CT scan, an enlarged SOV was confirmed. The diagnosis was confirmed via magnetic resonance imaging angiography, and the patient was successfully treated with embolization of the fistula. Thus, we recommend reviewing ophthalmic vein enlargement that is readily identifiable through noncontrast CT for patients injured by craniofacial trauma to suspect the presence of delayed CCF at their initial presentation.

Multidetector computer tomography and magnetic resonance imaging of double superior mesenteric veins: A case report

BACKGROUND This study aimed to describe the findings of double superior mesenteric veins (SMVs), a rare anatomical variation, on multidetector computer tomography (MDCT) and magnetic resonance imaging (MRI) images. CASE SUMMARY We describe the case of a 34-year-old male, who underwent both MDC and MRI examinations of the upper abdomen because of liver cirrhosis. MDCT and MRI angiography images of the upper abdomen revealed an anatomic variation of the superior mesenteric vein (SMV), the double SMVs. CONCLUSION The double SMVs are a congenital abnormality without potential clinical manifestation. Physicians need to be aware of this anatomical variation during abdominal surgery to avoid iatrogenic injury.

Giant cavernous aneurysms occluded by aneurysmal thrombosis, calcification, parent artery occlusion: A case report and review of literature

BACKGROUND Patients with giant intracranial aneurysms (GIAs) are at a high risk of rupture, morbidity, and mortality even after surgical or endovascular treatment. We described a case of a spontaneously occluded GIA secondary to gradual growth of the GIA, continuously progressed aneurysmal thrombosis, complete aneurysmal calcification and complete occlusion of the parent artery-the right internal carotid artery (RICA). CASE SUMMARY A 72-year-old female patient complained of sudden pain in her right eye upon admission to our hospital. She had been diagnosed with a GIA [30 mm (axial) × 38 mm (coronal) × 28 mm (sagittal)] containing an aneurysmal thrombus located in the cavernous sinus segment of RICA diagnosed by magnetic resonance imaging (MRI), enhanced MRI, and magnetic resonance angiography more than 14 years ago. Later, with slow growth of the cavernous carotid GIA, aneurysmal thrombosis progressed continuously, spontaneous occlusion of the RICA, complete aneurysmal calcification, and occlusion of the GIA occurred gradually. She had no history of subarachnoid hemorrhage but missed the chance for endovascular therapy at an early stage. As a result, she was left with severe permanent sequelae from the injuries to the right cranial nerves II, III, IV, V1/V2, and VI. CONCLUSION The risk of rupture of the cavernous carotid GIAs was relatively low and possibly further be reduced by the stasis flow and spontaneous occlusion of the parent artery internal carotid artery (ICA) induced by the mass effect of the cavernous carotid GIAs and the extremely rare aneurysmal calcification. However, nowadays, it is advisable to recommend early endovascular treatment for the cavernous carotid GIAs to prevent injuries to the surrounding intracranial nerves and occlusion of the ICA, mainly caused by the mass effect of the cavernous carotid GIAs.

Predicting impaired cerebrovascular reactivity and risk of hyperperfusion syndrome in carotid artery stenosis using BeamSAT magnetic resonance imaging

Pencil-beam presaturation (BeamSAT) magnetic resonance imaging (MRI) produces selective magnetic resonance angiography (MRA) images of specific arteries, including the unilateral internal carotid artery (ICA-selective MRA) or vertebral artery (VA-selective MRA). We evaluate the influence of flow pattern, visualized using BeamSAT MRI, on preoperative cerebral hemodynamic status and postoperative hyperperfusion syndrome (HPS). Patients undergoing carotid artery stenting or carotid endarterectomy were categorized into two groups to evaluate flow pattern. Patients with neither crossflow on BeamSAT MRI nor mismatch in middle cerebral artery (MCA) signal intensity between ICA-selective and conventional MRA were classified into Group I, comprising 29 patients. Group II included all other patients comprising 19 patients, who were suspected of experiencing changes in intracranial flow patterns. Cerebral blood flow and cerebrovascular reactivity (CVR) were assessed using single-photon emission computed tomography, and potential HPS symptoms were retrospectively assessed by chart review. Preoperative ipsilateral CVR was significantly lower in Group II than in Group I (18.0% ± 20.0% vs. 48.3% ± 19.5%; P < 0.0001). Group II showed significantly impaired CVR (odds ratio 17.7, 95% confidence interval 1.82–171; P = 0.013) in multivariate analysis. The partial areas under the curve of the BeamSAT logistic model (0.843) were significantly larger than those of the conventional logistic model (0.626) over the range of high sensitivity (0.6–1) (P = 0.04). The incidence of postoperative HPS symptoms was significantly higher in Group II than in Group I (8/19 vs. 1/29; P = 0.001). BeamSAT MRI may be a valuable and non-invasive tool for assessing cerebral hemodynamics and predicting postoperative HPS.

Anomalous Left Coronary Artery from the Pulmonary Artery (ALCAPA) Syndrome: Pathophysiology, Clinical Manifestations, and Management Strategies

Anomalous Left Coronary Artery from the Pulmonary Artery (ALCAPA) syndrome is a rare congenital cardiac anomaly characterized by the abnormal origin of the left coronary artery from the pulmonary artery instead of the aortic root. This anomaly results in compromised myocardial perfusion, particularly under conditions of increased oxygen demand, leading to myocardial ischemia, left ventricular dysfunction, and potentially severe complications such as mitral regurgitation, heart failure, and sudden cardiac death. The pathophysiology of ALCAPA involves a complex interplay of coronary artery steal phenomenon, collateral vessel development, and ventricular remodeling. Early diagnosis is critical, often achieved through echocardiography, cardiac MRI, or coronary angiography, which helps in planning surgical intervention. The mainstay of treatment is surgical correction to re-establish a dual coronary artery system, with techniques including direct reimplantation of the anomalous coronary artery into the aorta or the creation of an intrapulmonary tunnel. This article provides a comprehensive review of the current understanding of ALCAPA syndrome, emphasizing its pathophysiology, clinical presentation, diagnostic modalities, and surgical management, along with outcomes and prognostic factors.

Patient-specific cerebral 3D vessel model reconstruction using deep learning.

Three-dimensional vessel model reconstruction from patient-specific magnetic resonance angiography (MRA) images often requires some manual maneuvers. This study aimed to establish the deep learning (DL)-based method for vessel model reconstruction. Time of flight MRA of 40 patients with internal carotid artery aneurysms was prepared, and three-dimensional vessel models were constructed using the threshold and region-growing method. Using those datasets, supervised deep learning using 2D U-net was performed to reconstruct 3D vessel models. The accuracy of the DL-based vessel segmentations was assessed using 20 MRA images outside the training dataset. The dice coefficient was used as the indicator of the model accuracy, and the blood flow simulation was performed using the DL-based vessel model. The created DL model could successfully reconstruct a three-dimensional model in all 60 cases. The dice coefficient in the test dataset was 0.859. Of note, the DL-generated model proved its efficacy even for large aneurysms (> 10mm in their diameter). The reconstructed model was feasible in performing blood flow simulation to assist clinical decision-making. Our DL-based method could successfully reconstruct a three-dimensional vessel model with moderate accuracy. Future studies are warranted to exhibit that DL-based technology can promote medical image processing.

Synthesizing 4D Magnetic Resonance Angiography From 3D Time-of-Flight Using Deep Learning: A Feasibility Study.

Objective and background This study aimed to develop a deep convolutional neural network (DCNN) model capable of generating synthetic 4D magnetic resonance angiography (MRA) from 3D time-of-flight (TOF) images, allowing estimation of temporal changes in arterial flow. TOF MRA provides static information about arterial structures through maximum intensity projection (MIP) processing, but it does not capture the dynamic information of contrast agent circulation, which is lost during MIP processing. Considering the principles of TOF, it is hypothesized that dynamic information about arterial blood flow is latent within TOF signals. Although arterial spin labeling (ASL) can extract dynamic arterial information, ASL MRA has drawbacks, such as longer imaging times and lower spatial resolution than TOF MRA. This study's primary aim is to extend the utility of TOF MRA by training a machine-learning model on paired TOF and ASL data to extract latent dynamic information from TOF signals. Methods A DCNN combining a modified U-Net and a long-short-term memory (LSTM) network was trained on a dataset of 13 subjects (11 menand two women, aged 42-77 years) using paired 3D TOF MRA and 4D ASL MRA images. Subjects had no history of cerebral vessel occlusion or significant stenosis. The dataset was acquired using a 3T MRI system with a 32-channel head coil. Preprocessing involved resampling and intensity normalization of TOF and ASL images, followed by data augmentation and arterial mask generation. The model learned to extract flow information from TOF images and generate 8-phase 4D MRA images. The precision of flow estimation was evaluated using the coefficient of determination (R²) and Bland-Altman analysis. A board-certified neuroradiologist validated the quality of the images and the absence of significant stenosis in the major cerebral arteries. Results The generated 4D MRA images closely resembled the ground-truth ASL MRA data, with R² values of 0.92, 0.85, and 0.84 for the internal carotid artery (ICA), proximal middle cerebral artery (MCA), and distal MCA, respectively. Bland-Altman analysis revealed a systematic error of -0.06, with 95% agreement limits ranging from -0.18 to 0.12. Additionally, the model successfully identified flow abnormalities in a subject with left MCA stenosis, displaying a delayed peak and subsequent flattening distal to the stenosis, indicative of reduced blood flow. Visualization of the predicted arterial flow overlaid on the original TOF MRA images highlighted the spatial progression and dynamics of the flow. Conclusions The DCNN model effectively generated synthetic 4D MRA images from TOF images, demonstrating its potential to estimate temporal changes in arterial flow accurately. This non-invasive technique offers a promising alternative to conventional methods for visualizing and evaluating healthy and pathological flow dynamics. It has significant potential to improve the diagnosis and treatment of cerebrovascular diseases by providing detailed temporal flow information without the need for contrast agents or invasive procedures. The practical implementation of this model could enable the extraction of dynamic cerebral blood flow information from routine brain MRI examinations, contributing to the early diagnosis and management of cerebrovascular disorders.

Deep learning-based platform performs high detection sensitivity of intracranial aneurysms in 3D brain TOF-MRA: An external clinical validation study

PurposeTo evaluate the diagnostic efficacy of a developed artificial intelligence (AI) platform incorporating deep learning algorithms for the automated detection of intracranial aneurysms in time-of-flight (TOF) magnetic resonance angiography (MRA). MethodThis retrospective study encompassed 3D TOF MRA images acquired between January 2023 and June 2023, aiming to validate the presence of intracranial aneurysms via our developed AI platform. The manual segmentation results by experienced neuroradiologists served as the “gold standard”. Following annotation of MRA images by neuroradiologists using InferScholar software, the AI platform conducted automatic segmentation of intracranial aneurysms. Various metrics including accuracy (ACC), balanced ACC, area under the curve (AUC), sensitivity (SE), specificity (SP), F1 score, Brier Score, and Net Benefit were utilized to evaluate the generalization of AI platform. Comparison of intracranial aneurysm identification performance was conducted between the AI platform and six radiologists with experience ranging from 3 to 12 years in interpreting MR images. Additionally, a comparative analysis was carried out between radiologists’ detection performance based on independent visual diagnosis and AI-assisted diagnosis. Subgroup analyses were also performed based on the size and location of the aneurysms to explore factors impacting aneurysm detectability. Results510 patients were enrolled including 215 patients (42.16 %) with intracranial aneurysms and 295 patients (57.84 %) without aneurysms. Compared with six radiologists, the AI platform showed competitive discrimination power (AUC, 0.96), acceptable calibration (Brier Score loss, 0.08), and clinical utility (Net Benefit, 86.96 %). The AI platform demonstrated superior performance in detecting aneurysms with an overall SE, SP, ACC, balanced ACC, and F1 score of 91.63 %, 92.20 %, 91.96 %, 91.92 %, and 90.57 % respectively, outperforming the detectability of the two resident radiologists. For subgroup analysis based on aneurysm size and location, we observed that the SE of the AI platform for identifying tiny (diameter＜3mm), small (3 mm ≤ diameter＜5mm), medium (5 mm ≤ diameter＜7mm) and large aneurysms (diameter ≥ 7 mm) was 87.80 %, 93.14 %, 95.45 %, and 100 %, respectively. Furthermore, the SE for detecting aneurysms in the anterior circulation was higher than that in the posterior circulation. Utilizing the AI assistance, six radiologists (i.e., two residents, two attendings and two professors) achieved statistically significant improvements in mean SE (residents: 71.40 % vs. 88.37 %; attendings: 82.79 % vs. 93.26 %; professors: 90.07 % vs. 97.44 %; P < 0.05) and ACC (residents: 85.29 % vs. 94.12 %; attendings: 91.76 % vs. 97.06 %; professors: 95.29 % vs. 98.82 %; P < 0.05) while no statistically significant change was observed in SP. Overall, radiologists’ mean SE increased by 11.40 %, mean SP increased by 1.86 %, and mean ACC increased by 5.88 %, mean balanced ACC promoted by 6.63 %, mean F1 score grew by 7.89 %, and Net Benefit rose by 12.52 %, with a concurrent decrease in mean Brier score declined by 0.06. ConclusionsThe deep learning algorithms implemented in the AI platform effectively detected intracranial aneurysms on TOF-MRA and notably enhanced the diagnostic capabilities of radiologists. This indicates that the AI-based auxiliary diagnosis model can provide dependable and precise prediction to improve the diagnostic capacity of radiologists.

Triplicated middle cerebral arteries (duplicated and ipsilateral accessory) associated with triplicated anterior cerebral arteries (accessory) diagnosed by magnetic resonance angiography.

To describe a case of duplicated middle cerebral artery (MCA) combined with ipsilateral accessory MCA, forming a triplicated MCA, associated with the accessory anterior cerebral artery (ACA), forming a triplicated A2 segment of the ACA detected incidentally on magnetic resonance (MR) angiography. A 70-year-old woman with internal carotid artery (ICA) stenosis at the origin, which was detected by ultrasound, underwent cranial MR imaging and MR angiography of the intracranial region for an evaluation of brain and cerebral arterial lesions. The MR machine was a 3-Tesla scanner. MR angiography was performed using a standard 3-dimensional time-of-flight technique. Multiple ischemic white matter lesions are observed. No significant stenotic lesions were observed in intracranial arteries. The right duplicated MCA was originated from right distal ICA. And main MCA was originated from right ICA bifurcation. Right accessory MCA was arisen from the A2 segment of the right ACA. Thus, the right MCA was triplicated. There was also an accessory ACA forming a triplicated ACA at its A2 segment. These findings were clearly identified on partial volume-rendering (VR) images. We herein report a case of triplicated MCA associated with triplicated ACA. MCA variations are relatively rare, and this is the third case of triplicated MCA reported in relevant English-language literature. To identify multiple cerebral arterial variations, creating partial VR images using MR angiographic source images is useful.

Facile Synthesis of Rigid Binuclear Manganese Complexes for Magnetic Resonance Angiography and SLC39A14-Mediated Hepatic Imaging.

Manganese(II)-based contrast agents (MBCAs) are potential candidates for gadolinium-free enhanced magnetic resonance imaging (MRI). In this work, a rigid binuclear MBCA (Mn2-PhDTA2) with a zero-length linker was developed via facile synthetic routes, while the other dimer (Mn2-TPA-PhDTA2) with a longer rigid linker was also synthesized via more complex steps. Although the molecular weight of Mn2-PhDTA2 is lower than that of Mn2-TPA-PhDTA2, their T1 relaxivities are similar, being increased by over 71% compared to the mononuclear Mn-PhDTA. In the presence of serum albumin, the relaxivity of Mn2-PhDTA2 was slightly lower than that of Mn2-TPA-PhDTA2, possibly due to the lower affinity constant. The transmetalation reaction with copper(II) ions confirmed that Mn2-PhDTA2 has an ideal kinetic inertness with a dissociation half-life of approximately 10.4 h under physiological conditions. In the variable-temperature 17O NMR study, both Mn-PhDTA and Mn2-PhDTA2 demonstrated a similar estimated q close to 1, indicating the formation of monohydrated complexes with each manganese(II) ion. In addition, Mn2-PhDTA2 demonstrated a superior contrast enhancement to Mn-PhDTA in in vivo vascular and hepatic MRI and can be rapidly cleared through a dual hepatic and renal excretion pattern. The hepatic uptake mechanism of Mn2-PhDTA2 mediated by SLC39A14 was validated in cellular uptake studies.

Cerebral Venous Thrombosis Indicative of Polycythemia Vera: Case Report

Polycythemia vera, a myeloproliferative disorder, seldom leads to cerebral venous thrombosis, making this association a rare occurrence. Here, we present the case of a 62-year-old patient without significant medical history, who was admitted due to a one-month history of intracranial hypertension syndrome. Upon admission, papillary edema (stage II) was observed, along with a lack of focal neurological signs. MRI angiography revealed thrombosis in the right lateral sinus. Further diagnostic investigation confirmed the presence of polycythemia vera. The patient was initiated on anti-edematous and anticoagulant therapy, followed by bloodlettings and cyto-reduction treatment, resulting in a favorable clinical outcome.

SurLym trial: study protocol for a multicentre pragmatic randomised controlled trial on the added value of reconstructive lymphatic surgery to decongestive lymphatic therapy for the treatment of lymphoedema

IntroductionLymphoedema is a chronic condition caused by lymphatic insufficiency. It leads to swelling of the limb/midline region and an increased risk of infection. Lymphoedema is often associated with mental and...

Cognitive impairment in asymptomatic carotid artery stenosis is associated with abnormal segments in the Circle of Willis

ObjectiveOur group has previously demonstrated that patients with asymptomatic carotid artery stenosis (ACAS) demonstrate cognitive impairment. One proposed mechanism for cognitive impairment in patients with ACAS is cerebral hypoperfusion due to flow-restriction. We tested whether the combination of a high-grade carotid stenosis and inadequate cross-collateralization in the Circle of Willis (CoW) resulted in worsened cognitive impairment. MethodsTwenty-four patients with high-grade (≥70% diameter-reducing) ACAS underwent carotid duplex ultrasound, cognitive assessment, and 3D time-of-flight magnetic resonance angiography. The cognitive battery consisted of nine neuropsychological tests assessing four cognitive domains: learning and recall, attention and working memory, motor and processing speed, and executive function. Raw cognitive scores were converted into standardized T-scores. A structured interpretation of the magnetic resonance angiography images was performed with each segment of the CoW categorized as being either normal or abnormal. Abnormal segments of the CoW were defined as segments characterized as narrowed or occluded due to congenital aplasia or hypoplasia, or acquired atherosclerotic stenosis or occlusion. Linear regression was used to estimate the association between the number of abnormal segments in the CoW, and individual cognitive domain scores. Significance was set to P < .05. ResultsThe mean age of the patients was 66.1 ± 9.6 years, and 79.2% (n = 19) were male. A significant negative association was found between the number of abnormal segments in the CoW and cognitive scores in the learning and recall (β = −6.5; P = .01), and attention and working memory (β = −7.0; P = .02) domains. There was a trend suggesting a negative association in the motor and processing speed (β = −2.4; P = .35) and executive function (β = −4.5; P = .06) domains that did not reach significance. ConclusionsIn patients with high-grade ACAS, the concomitant presence of increasing occlusive disease in the CoW correlates with worse cognitive function. This association was significant in the learning and recall and attention and working memory domains. Although motor and processing speed and executive function also declined numerically with increasing abnormal segments in the CoW, the relationship was not significant. Since flow restriction at a carotid stenosis compounded by inadequate collateral compensation across a diseased CoW worsens cerebral perfusion, our findings support the hypothesis that cerebral hypoperfusion underlies the observed cognitive impairment in patients with ACAS.

Left posterior cerebral artery occlusion following minor head trauma: a case report

A 17-year-old male patient who received a punch behind the left ear 2 days ago, was admitted to the emergency room with a headache and dizziness. His neurological examination was normal. Brain CT images demonstrated diffuse hypodense areas and sulcus deletion in the left occipital lobe. On MR images, diffusion restriction for acute ischemia in the left PCA watershed area was determined, and hospitalization was recommended. However, he and his relatives left the hospital. Through the electronic information system called “e-nabız”, it was learned that the patient was hospitalized in an external center and treated with antiplatelet and anticoagulant regimens for ten days due to an acute thrombus at the left PCA P1 distal-P2 level observed on the brain CT and MR angiography images. In our clinic, his neurological examination was completely normal thirty days later. Still, a visual field examination revealed a total quadrianopsy in the upper temporal pole on the right and left eyes. An encephalomalacia in the left PCA watershed area was observed on CT images. The findings of this case showed that minor head trauma in children can cause large vessel occlusion and therefore close follow-up of these children for a certain time would be appropriate.

Intensity Score of Vessel Wall Contrast Enhancement in MRI Allows Prediction of Disease Progression in Moyamoya Angiopathy.

The underlying pathophysiological cause of moyamoya angiopathy (MMA) is still unclear. High-resolution vessel wall imaging has become a useful tool. The aim was to study vessel wall contrast-enhancement (VW-CE) as an imaging marker to predict disease progression in MMA. Patients with MMA, who had undergone serial contrast-enhanced high-resolution MRI with concomitant and follow-up digital subtraction angiography, were analyzed retrospectively. VW-CE was semiquantified by measurement of the signal intensity of the vessel wall in in contrast-enhanced high-resolution MRI. A comparative quotient with the contrast-intensity of the pituitary stalk was calculated and graded accordingly from grade 1 to 5. VW-CE status was correlated with disease status, stroke, cerebrovascular reactivity in CO2-triggered blood-oxygen level-dependent MRI, angiographic disease progression, revascularization surgery, and follow-up imaging. Forty eight patients met the inclusion criteria. N = 56 MRI and digital subtraction angiography time-intervals were evaluated for 12 vessel sections per hemisphere each (N = 1344). N = 38 (79%) patients showed VW-CE and N = 10 (21%) did not. VW-CE was only observed in the terminal internal carotid artery and the proximal circle of Willis (N = 96/1344). Notably, patients with VW-CE significantly more often presented with acute infarction in the concomitant MRI. The incidence of angiographically proven disease progression was significantly associated with the incidence of VW-CE, and time to disease progression was earlier in higher grades of VW-CE compared with lower grades. VW-CE is a semiquantifiable marker for disease activity in patients with MMA and associated with disease progression and increased risk of stroke. VW-CE analysis can be routinely performed in patients with MMA to estimate the risk for disease progression and stroke.

In silico analysis of embolism in cerebral arteries using fluid-structure interaction method

Ischemic stroke, particularly embolic stroke, stands as a significant global contributor to mortality and long-term disabilities. This paper presents a comprehensive simulation of emboli motion through the middle cerebral artery (MCA), a prevalent site for embolic stroke. Our patient-specific computational model integrates major branches of the middle cerebral artery reconstructed from magnetic resonance angiography images, pulsatile flow dynamics, and emboli of varying geometries, sizes, and material properties. The fluid-structure interactions method is employed to simulate deformable emboli motion through the middle cerebral artery, allowing observation of hemodynamic changes in artery branches upon embolus entry. We investigated the impact of embolus presence on shear stress magnitude on artery walls, analyzed the effects of embolus material properties and geometries on embolus trajectory and motion dynamics within the middle cerebral artery. Additionally, we evaluated the non-Newtonian behavior of blood, comparing it with Newtonian blood behavior. Our findings highlight that embolus geometry significantly influences trajectory, motion patterns, and hemodynamics within middle cerebral artery branches. Emboli with visco-hyperelastic material properties experienced higher stresses upon collision with artery walls compared to those with hyperelastic properties. Furthermore, considering blood as a non-Newtonian fluid had notable effects on emboli stresses and trajectories within the artery, particularly during collisions. Notably, the maximum von Mises stress experienced in our study was 21.83 kPa, suggesting a very low probability of emboli breaking during movement, impact, and after coming to a stop. However, in certain situations, the magnitude of shear stress on them exceeded 1 kPa, increasing the likelihood of cracking and disintegration. These results serve as an initial step in anticipating critical clinical conditions arising from arterial embolism in the middle cerebral artery. They provide insights into the biomechanical parameters influencing embolism, contributing to improved clinical decision-making for stroke management.

Automatic detection method of intracranial aneurysms on maximum intensity projection images based on SE-CaraNet

Conventional maximum intensity projection (MIP) images tend to ignore some morphological features in the detection of intracranial aneurysms, resulting in missed detection and misdetection. To solve this problem, a new method for intracranial aneurysm detection based on omni-directional MIP image is proposed in this paper. Firstly, the three-dimensional magnetic resonance angiography (MRA) images were projected with the maximum density in all directions to obtain the MIP images. Then, the region of intracranial aneurysm was prepositioned by matching filter. Finally, the Squeeze and Excitation (SE) module was used to improve the CaraNet model. Excitation and the improved model were used to detect the predetermined location in the omni-directional MIP image to determine whether there was intracranial aneurysm. In this paper, 245 cases of images were collected to test the proposed method. The results showed that the accuracy and specificity of the proposed method could reach 93.75% and 93.86%, respectively, significantly improved the detection performance of intracranial aneurysms in MIP images.