J Neuroimaging [JOURNAL]
Sun
200 papers
Sex Differences in White Matter Structure in Attention Deficit Hyperactivity Disorder: MR Diffusion Fixel-Based Analysis.
Yu Y, Fu J, Wang M … +4 more , Zhou R, Shan C, Sun X, Feng Y
J Neuroimaging · 2025 · PMID 40746166 · Publisher ↗
BACKGROUND AND PURPOSE: Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder prevalent among adolescents and exhibits notable sex dimorphism. Despite an increasing body of research, the impact...
BACKGROUND AND PURPOSE: Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder prevalent among adolescents and exhibits notable sex dimorphism. Despite an increasing body of research, the impact of sex on ADHD remains underexplored. This study aimed to examine sex differences in white matter organization in children with ADHD using magnetic resonance (MR) diffusion data analyzed with fixel-based analysis (FBA), a novel technique that enables detailed assessment of both microstructural and macrostructural properties of white matter. METHODS: Fifty-five children with ADHD and 37 age-matched typically developing controls underwent MR diffusion. FBA was used to assess white matter structure. Group comparisons examined sex differences within and between groups, and correlation analyses were conducted between white matter features and clinical symptoms in the ADHD group. RESULTS: The results demonstrated that no significant sex differences were identified among healthy controls. However, within the ADHD group, the fiber cross-section (FC) metric revealed significant white matter alterations in several tracts, including the arcuate fasciculus, corpus callosum (CC), cingulum (CG), superior longitudinal fascicle, striato-fronto-orbital (ST_FO), and striato-precentral. In addition, the fiber density and cross-section metrics showed comparable abnormalities in the CC, CG, and ST_FO. Females with ADHD showed stronger correlations between FC metrics in bundles of white matter and clinical symptoms. CONCLUSIONS: This study is the first to demonstrate sex differences in ADHD white matter bundles using FBA, contributing to a deeper understanding of the pathological mechanisms of ADHD and offering new insights for its diagnosis and treatment.
Endovascular Therapy Outcomes for Cerebral Vasospasm in Poor-Grade Aneurysmal Subarachnoid Hemorrhage.
Fakih R, Bhatti IA, Ahmed R … +5 more , Ma X, Gillani SA, Siddiq F, Gomez CR, Qureshi AI
J Neuroimaging · 2025 · PMID 40739952 · Publisher ↗
BACKGROUND AND PURPOSE: The impact of endovascular therapy (EVT) on outcomes in World Federation of Neurological Societies (WFNS) grade ≥ 4 aneurysmal subarachnoid hemorrhage (aSAH) remains unclear. METHODS: We conducted...
BACKGROUND AND PURPOSE: The impact of endovascular therapy (EVT) on outcomes in World Federation of Neurological Societies (WFNS) grade ≥ 4 aneurysmal subarachnoid hemorrhage (aSAH) remains unclear. METHODS: We conducted a retrospective cohort study of 80 patients with WFNS grade ≥ 4 aSAH and secondary vasospasm treated between 2010 and 2023. EVT included intra-arterial vasodilators and/or balloon angioplasty. The primary outcome was favorable functional status at 90 days (modified Rankin Scale 0-3). Multivariable logistic regression was used to assess associations between EVT and outcomes, adjusting for age, sex, and time-to-aneurysm securement. RESULTS: EVT was performed in 77.5% of patients (n = 62). Favorable outcomes occurred in occurred in 42.5% of all patients (n = 34), and were significantly more frequent in the EVT group (48.4% versus 22.2%; p = 0.038). EVT was independently associated with greater odds of favorable outcome (adjusted odds ratio [aOR] 3.15, 95% confidence interval [CI] 1.12-8.85; p = 0.030) and reduced mortality (aOR 0.24, 95% CI 0.07-0.82; p = 0.023). Early aneurysm treatment (≤ 12 h) also independently predicted favorable outcomes (aOR 2.38, p = 0.044) and lower mortality (aOR 0.42, p = 0.045). CONCLUSIONS: Among patients with poor-grade aSAH and vasospasm, EVT was independently associated with improved functional outcomes and survival. These findings challenge historical nihilism and support timely, aggressive endovascular intervention as a critical component of care in this high-risk population.
Neuroimaging Training Programs, Certification Pathways, and Credentialing Issues.
Muzammil SM, Pirahanchi Y, Tarabichi A … +1 more , Masdeu JC
J Neuroimaging · 2025 · PMID 40739942 · Publisher ↗
Neurologists have a unique ability to interpret neuroimaging in conjunction with clinical context and disease pathology, making their role vital in accurate interpretation. Neuroimaging education is essential for enhanci...
Neurologists have a unique ability to interpret neuroimaging in conjunction with clinical context and disease pathology, making their role vital in accurate interpretation. Neuroimaging education is essential for enhancing these skills, typically provided through neurology residency programs and specialized neuroimaging fellowships. Neuroimaging training experience in neurology residency programs can be quite variable. Neurology residents typically gain substantial exposure to neuroimaging techniques through the sheer volume of cases they encounter during training, often under direct guidance of subspeciality neurologists. However, curriculum implementation and proper documentation of training often lacks consistency, and opportunities for advanced neuroimaging training are limited. The number of fellowship-trained neuroimaging specialists is insufficient to meet the growing demand for neuroimaging expertise. Credentialing and certification issues related to neuroimaging training for neurologists hinder the integration of qualified neurologists into the neuroimaging field. The need for additional years of specialized training, financial burden associated with maintaining certification, opposition by radiological societies, complexities of reimbursement which vary by insurer, region, and hospital policies are some of the challenges. This article explores these issues and suggests that solutions may include the establishment of more accredited neuroimaging fellowship programs or an increase in the neuroimaging component of subspecialty training, as well as addressing credentialing and hospital privileging issues.
Multimodal Quantitative MRI Atlas of the Human Brain in Healthy Young Adults.
Pfirrmann J, Adlung A, Hermann I … +5 more , Weber CE, Ebert A, Zöllner FG, Gass A, Eisele P
J Neuroimaging · 2025 · PMID 40714992 · Publisher ↗
BACKGROUND AND PURPOSE: Quantitative MRI provides insights into (patho-) physiological processes of the brain macro- and microstructure. In this study, we applied a multimodal MRI approach to determine quantitative value...
BACKGROUND AND PURPOSE: Quantitative MRI provides insights into (patho-) physiological processes of the brain macro- and microstructure. In this study, we applied a multimodal MRI approach to determine quantitative values of the brain in healthy young adults. METHODS: 3 T MRI including sodium MRI (4.0 mm nominal isotropic resolution), 3D T1-weighted magnetization-prepared rapid acquisition gradient-echo (spatial resolution = 0.9 mm × 0.9 mm × 0.9 mm), T2-fluid attenuated inversion recovery (spatial resolution = 0.4 mm × 0.4 mm × 5.0 mm), diffusion-weighted imaging (spatial resolution = 1.0 mm × 1.0 mm × 4.0 mm), PD/T2 (spatial resolution = 1.0 mm × 1.0 mm × 2.0 mm), and MR fingerprinting including T1 and T2* relaxation times (spatial resolution = 1 mm × 1 mm × 2 mm) was performed on 40 healthy young adults (28 women, mean age: 24.55 years). RESULTS: Mean values for the gray matter were as follows-apparent diffusion coefficient (ADC): 0.95 ± 0.03 × 10 mm/s, total sodium concentration (TSC): 41.99 ± 2.35 mM, T1: 1338.04 ± 46.29 ms, T2*: 63.39 ± 2.94 ms. For the white matter, mean values were as follows-ADC: 0.79 ± 0.02 × 10 mm/s, TSC: 36.08 ± 5.62 mM, T1: 968.47 ± 48.35 ms, T2*: 53.62 ± 8.06 ms, and for the deep gray matter, mean values were as follows-ADC: 0.85 ± 0.04 × 10 mm/s, TSC: 38.23 ± 2.91 mM, T1: 1087.24 ± 39.77 ms, T2*: 54.53 ± 7.15. CONCLUSION: Our multimodal, quantitative MRI atlas of the human brain in healthy young adults provides meaningful in vivo insights into the brain microstructure and can be used for reference in future studies.
A Radiomic Approach to Clinical MRI Refines the Thalamus-Cognition Link in Multiple Sclerosis.
Buyukturkoglu K, Lu L, Davis L … +13 more , Orellana RE, White CC, Sun R, Ozcelik S, Isenstein NM, Onomichi KB, Iqbal R, Zhao B, Stern Y, Zeydan B, Kantarci OH, Riley CS, De Jager PL
J Neuroimaging · 2025 · PMID 40685506 · Publisher ↗
BACKGROUND AND PURPOSE: Radiomics extracts imaging features that may not be detectable through conventional volumetric analyses. Given their role in multiple sclerosis (MS), we applied radiomics to thalamic nuclei and ex...
BACKGROUND AND PURPOSE: Radiomics extracts imaging features that may not be detectable through conventional volumetric analyses. Given their role in multiple sclerosis (MS), we applied radiomics to thalamic nuclei and examined their associations with cognitive performance. METHODS: A total of 601 individuals were included (342 people with MS [PwMS] from two cohorts and 259 healthy controls [HC]). Radiomic features (RF) and volumes were extracted from the whole thalamus, five thalamic nuclei, and the putamen segmented on three-dimensional T1-weighted images. Cognitive performance was assessed using the Symbol Digit Modalities Test (SDMT) and Paced Auditory Serial Addition Test (PASAT) in PwMS and the Digit Symbol Substitution Test (DSST) in HC. In the first MS cohort, multivariate linear regression in a discovery set (N = 103) identified thalamus-derived RF associated with SDMT, which were retested in a replication set (N = 63). Their associations with PASAT in a second MS cohort (N = 176) and DSST in HC were also evaluated. We then tested whether the same RFs, when extracted from the putamen, was associated with SDMT. Least Absolute Shrinkage and Selection Operator (LASSO) models assessed the combined predictive value of RF and volumes. RESULTS: Twenty-eight RF-region of interest (ROI) pairs were associated with SDMT in the replication set (false discovery rate [FDR] < 0.05). Of these, 24 were also associated with PASAT (FDR ≤ 0.03), and 2 with DSST. Only ventral nuclei volume showed replicated associations among volumetrics. Only four putamen-derived pairs were associated with SDMT (FDR = 0.04). LASSO results confirmed RF outperformed volumes. CONCLUSION: RF extracted from the thalamus is strongly associated with cognitive performance in PwMS, outperforming volumetric measures and supporting their potential as sensitive imaging biomarkers.
Double Stent Retriever Mechanical Thrombectomy for Distal Medium Vessel Clots in the Middle Cerebral Artery: Initial Experience.
Méndez JC, Vega P, Lopez-Frías A … +13 more , Díaz T, Puig J, Murias E, Blasco J, Pérez-García C, Maestro V, Moreu M, Comas-Cufí M, Cruz-Culebras A, Prieto MA, Bermúdez-Coronel I, Blázquez J, Masjuán J
J Neuroimaging · 2025 · PMID 40685504 · Publisher ↗
BACKGROUND AND PURPOSE: Mechanical thrombectomy (MT) is increasingly performed for distal medium vessel occlusions (DMVOs) of the anterior circulation in acute stroke patients. Although trials have not shown superiority...
BACKGROUND AND PURPOSE: Mechanical thrombectomy (MT) is increasingly performed for distal medium vessel occlusions (DMVOs) of the anterior circulation in acute stroke patients. Although trials have not shown superiority over usual care, selected patients may still benefit from MT. The ideal endovascular technique is debated. We aimed to determine the safety and efficacy of double stent retriever MT (DSR-MT) for DMVOs. METHODS: We retrospective analyzed demographics, procedure characteristics, and clinical data from consecutive patients with acute primary DMVOs treated with DSR-MT at four comprehensive stroke centers. Reperfusion was defined by the extended Thrombolysis In Cerebral Infarction (eTICI) score. Clinical outcomes were measured by the National Institute of Health Stroke Scale (NIHSS) and modified Rankin scale (mRS) scores. RESULTS: We included 32 patients (median age, 78 years, interquartile range [IQR] 71-82; 16 [50%] female), of whom 26 (81.2%) had primary occlusion of the M2 segment of the middle cerebral artery and six (18.8%) had occlusion of M3. Clinical severity was moderate (median, NIHSS 13; IQR 10-15) in 24 patients (75%). First-pass effect (eTICI 2c/3) was achieved in 20 patients (62.5%). Final eTICI 2b/2c/3 was achieved in 30 patients (93.7%) and final eTICI 2c/3 in 25 (78.1%). Symptomatic intracranial hemorrhage developed in one patient (3.1%). Median NIHSS was 6 at 24 h (IQR 3-12) and 4 at discharge (IQR 1-9). At 90 days, 22 (73.3%) patients were functionally independent (mRS 0-2). CONCLUSIONS: This preliminary study found good efficacy and safety of DSR-MT for DMVOs in patients with M2 and M3 occlusions.
Association of Carotid Plaque Calcification Attenuation With Intraplaque Hemorrhage Volume: 3D-Segmentation Analysis.
Rubin J, Cao Q, Sakai Y … +9 more , Arnett N, Phi HQ, Hu AC, Cucchiara BL, Bos D, Saba L, Johannson E, Zee J, Song JW
J Neuroimaging · 2025 · PMID 40658028 · Full text
BACKGROUND AND PURPOSE: Despite the high prevalence of plaque calcifications in carotid atherosclerosis, the association between morphologic and attenuation features of calcifications and intraplaque hemorrhage (IPH) rem...
BACKGROUND AND PURPOSE: Despite the high prevalence of plaque calcifications in carotid atherosclerosis, the association between morphologic and attenuation features of calcifications and intraplaque hemorrhage (IPH) remains unclear. METHODS: Calcific carotid plaques were identified on neck computed tomography angiographies (CTAs) from patients meeting criteria for embolic stroke of undetermined source. Plaque calcifications were manually segmented using 3D-Slicer to quantify features, including volume and attenuation (Hounsfield Units [HU]). IPH volume (IPHvol) was quantified using a semi-automated software. A linear mixed regression model evaluated associations between calcification features and IPHvol, adjusting for sex, age, and cardiovascular risk factors. An interaction term between calcification volume and attenuation was included after dichotomizing attenuation (>924HU) and volume (>30 millimeter [mm]) as high versus low on the basis of median values. RESULTS: From 70 patients (median age 68 years, 50% female), 116 calcific plaques containing 269 plaque calcifications were analyzed. Adjusting for age, cardiovascular risk factors, and plaque calcification features, being female showed lower IPHvols compared to males (mean ratio 0.34, p = 0.002). A significant interaction between calcification volume and attenuation emerged (p = 0.042). Among plaques with low plaque calcification volumes, plaques with low-attenuation (<924HU) calcifications showed 5.53 times higher IPHvols than plaques with high-attenuation calcifications (p = 0.003). Among plaques with high-attenuation calcifications, plaques with high volumes of these calcifications showed 4.40 times higher IPHvols compared to low-volumes of high-attenuation calcifications (p = 0.011). CONCLUSIONS: Plaque calcification attenuation characteristics are associated with IPHvols. Understanding calcification patterns that correlate with IPH could enable clinicians to infer plaque instability from readily visible calcifications on CTA.
Middle Longitudinal Fascicle Maldevelopment on Free Water Corrected MR Diffusion Underlies Language Impairment in Autism.
Cao D, Ni L, Qi Q … +7 more , Zhou L, Zhang W, Wang Y, Zhu L, Ma G, Zhang F, Li S
J Neuroimaging · 2025 · PMID 40613571 · Publisher ↗
BACKGROUND AND PURPOSE: The middle longitudinal fascicle (MdLF), a recently characterized white matter tract within the ventral language network, remains understudied in autism spectrum disorder (ASD). We hypothesized th...
BACKGROUND AND PURPOSE: The middle longitudinal fascicle (MdLF), a recently characterized white matter tract within the ventral language network, remains understudied in autism spectrum disorder (ASD). We hypothesized that altered microstructural development of the MdLF contributes to language impairment in children with ASD. METHODS: Free water corrected diffusion magnetic resonance imaging (MRI) tractography was employed to reconstruct the MdLF in 57 children with ASD (5.79±0.99 years) and 37 matched typically developing (TD) controls (5.99±1.38 years), aged 4-9 years. Language impairment was assessed using the Autism Behavior Checklist language subscale. General linear models and partial correlations (covarying age) were applied to investigate age-related differences of diffusion metrics and the correlation of diffusion metrics with language impairment in ASD. RESULTS: Significant age-by-group interactions emerged for bilateral MdLF fractional anisotropy tissue (FA) (TD: left/right β = 0.614/0.511, p < 0.01; ASD: p > 0.05) and axial diffusivity tissue (AD) (ASD: left/right β = -0.458/-0.348, p < 0.05; TD: p > 0.05). In ASD, FA (r = -0.441, p < 0.001) and AD (r = -0.28, p = 0.037) were negatively correlated with language impairment, while radial diffusivity tissue showed a positive correlation (r = 0.355, p = 0.007) in the right MdLF. There were no significant between-group differences found in diffusion metrics. CONCLUSIONS: The MdLF exhibits aberrant developmental trajectories in preschool children with ASD, and its microstructural integrity is linked to language impairment. These findings underscore the MdLF's role in ASD-related language deficits and highlight the importance of early neurodevelopmental assessment.
Blood-Brain Barrier Dysfunction in Adults With Heart Failure.
Roy B, Shao X, Jobanputra KJ … +4 more , Fonarow GC, Wang DJJ, Woo M, Kumar R
J Neuroimaging · 2025 · PMID 40613567 · Full text
BACKGROUND AND PURPOSE: Heart failure (HF) patients show brain tissue injury in sites that mediate autonomic, cognitive, and mood dysfunctions that are linked with increased morbidity and mortality. The pathological mech...
BACKGROUND AND PURPOSE: Heart failure (HF) patients show brain tissue injury in sites that mediate autonomic, cognitive, and mood dysfunctions that are linked with increased morbidity and mortality. The pathological mechanisms that may contribute to brain tissue injury in HF are unclear, but may include blood brain barrier (BBB) dysfunction. METHODS: We performed diffusion-weighted pseudo-continuous arterial spin labeling (DW-pCASL) in 27 HF and 59 controls to examine BBB, using a 3.0-Tesla MRI scanner, and assessed anxiety, depressive symptoms, and cognition. Using DW-pCASL data, arterial transit time (ATT, an index of large artery integrity) and water exchange rates across the BBB (Kw, an index of BBB function) maps were generated, normalized, smoothed, and compared between HF and controls, and correlated with cognition and mood. RESULTS: Significantly increased mood deficits and reduced cognition appeared in HF over controls. Multiple brain areas, which are involved in mediating cognition and mood, showed altered Kw and ATT values in HF over controls. Increased Kw emerged in the insula, hippocampus, and cerebellum. ATT values decreased in the prefrontal cortices, cingulate, and cerebellum, and increased in a few sites in HF patients. Kw values from regions that are involved in mood and cognition functions showed significant associations with anxiety, depression, and cognition. CONCLUSIONS: HF patients show impaired BBB function and altered large artery integrity. BBB alterations may introduce neural damage to autonomic, mood, and cognitive regulatory areas, contributing to abnormal functions found in HF. The findings suggest a need to repair BBB function to rescue brain tissue and functions in this condition.
Contact Aspiration Alone or Combined With Stent Retriever Thrombectomy for Middle Cerebral Artery Large Vessel Occlusion.
Navia P, Fernandez-Prieto A, Alvarez-Muelas A … +27 more , Calleja Á, Ortega J, Domínguez C, Sagredo A, Rodríguez-Benítez A, García-Villanego J, Martínez-Calvo A, Cubillo-Prieto D, de la Rosa C, Mosqueira A, Bermejo-Garcés R, Chaviano J, Bermúdez-Coronel I, Pérez-García C, Rodriguez-Paz CM, Hidalgo-Barranco C, Maynar J, Caniego JL, Molina-Nuevo JD, Maestro V, Sanchís-García JM, Balboa O, Martínez-Galdamez M, Garmendia E, Comas-Cufí M, Puig J, Zamarro J
J Neuroimaging · 2025 · PMID 40605686 · Full text
BACKGROUND AND PURPOSE: The effectiveness of a large-bore aspiration catheter for contact aspiration (CA) thrombectomy is compared to the combined use of an aspiration catheter and a stent retriever (CA+SR) for large ves...
BACKGROUND AND PURPOSE: The effectiveness of a large-bore aspiration catheter for contact aspiration (CA) thrombectomy is compared to the combined use of an aspiration catheter and a stent retriever (CA+SR) for large vessel occlusion (LVO). We assessed the efficacy and safety of CA alone versus CA+SR as first-line treatment for middle cerebral artery (MCA) LVO in daily practice. METHODS: We retrospectively analyzed data from the SARA-3 registry of patients with MCA occlusion (M1 and M2 segments), dividing them into two groups: first-line CA alone and combined CA+SR. Demographic, clinical, angiographic, and clinical outcomes (National Institute of Health Stroke Scale score at 24 h and modified Rankin Scale [mRS] score at 3 months) were compared. RESULTS: Of 551 patients, 348 (63.8%) received CA alone and 203 (36.8%) received CA+SR. The groin-to-reperfusion time was significantly shorter in the CA-alone group than in the combined CA+SR group (median, 26 vs. 40 min, p < 0.001). The CA group demonstrated higher first-pass modified Thrombolysis In Cerebral Infarction (mTICI) 3 recanalization rates (47% vs. 37%; adjusted odds ratio [OR] 1.5 [confidence interval 1-2.1], p = 0.042), a higher final mTICI 3 rate (65% vs. 56%; OR 1.5 [1-2.2], p = 0.037), and fewer new territory embolisms (0.9% vs. 3.9%; OR 0.2 [0-0.8], p = 0.028) compared to the CA+SR group. The CA-alone group had better functional outcomes at 3 months (mRS ≤ 2, 77% vs. 63%; OR 1.9 [1.3-3], p = 0.003). CONCLUSIONS: CA alone outperformed CA+SR as a first-line treatment for MCA LVO, yielding higher first-pass and final recanalization rates, lower new territory embolism risk, shorter procedure times, and better functional outcomes at 3 months.
Conventional and Advanced Imaging Features of CNS Intravascular Lymphoma.
Cheewadhanaraks S, Rapalino O
J Neuroimaging · 2025 · PMID 40605673 · Publisher ↗
BACKGROUND AND PURPOSE: Intravascular lymphoma (IVL) is a rare and aggressive lymphoma subtype that poses diagnostic challenges due to its nonspecific clinical presentation. This study aimed to evaluate the imaging findi...
BACKGROUND AND PURPOSE: Intravascular lymphoma (IVL) is a rare and aggressive lymphoma subtype that poses diagnostic challenges due to its nonspecific clinical presentation. This study aimed to evaluate the imaging findings of this disease in the CNS and to assess the diagnostic potential of advanced imaging techniques, including dynamic susceptibility contrast (DSC) perfusion, magnetic resonance spectroscopy (MRS), and fluorine-18 fluorodeoxyglucose (FDG) PET. METHODS: Twenty-one pathologically confirmed cases of IVL with CNS involvement were evaluated. Two cases underwent DSC perfusion, three underwent MRS, and three underwent FDG PET. RESULTS: Ninety percent of patients had intracranial imaging findings. The most common imaging pattern on brain MRI was infarct-like lesions (68%), followed by mass-like enhancement and nonspecific white matter changes (11% each). The remaining findings included enhancing lesions without mass effect and a central pontine T2/fluid-attenuated inversion recovery hyperintensity, each observed in one patient. T2* imaging abnormalities were found in 60% of cases. Vascular irregularity on noninvasive angiographic imaging was observed in 30% of cases. Spinal intradural involvement was found in four cases (19%), including three cases with nerve root enhancement and one case with spinal cord infarction. MRS showed variable choline/creatine ratios elevation in two out of three cases. No cases showed apparent cerebral blood volume elevation on DSC perfusion or increased uptake on FDG PET. CONCLUSION: Several imaging findings can be observed in CNS IVL, with infarct-like lesions being the most common. Awareness of these imaging features is crucial for the accurate diagnosis of this challenging entity.
Brain Microstructure Interrogation by Diffusion Tensor and Kurtosis Imaging in Progressive Supranuclear Palsy Subtypes.
Gatto RG, Youssef H, Pham NTT … +7 more , Ali F, Clark HM, Stierwalt J, Stephens Y, Machulda MM, Josephs KA, Whitwell JL
J Neuroimaging · 2025 · PMID 40556376 · Full text
BACKGROUND AND PURPOSE: Diffusion tensor imaging (DTI) is commonly used to assess the integrity of gray and white matter (WM) structures in progressive supranuclear palsy (PSP). Beyond DTI, nontraditional diffusion techn...
BACKGROUND AND PURPOSE: Diffusion tensor imaging (DTI) is commonly used to assess the integrity of gray and white matter (WM) structures in progressive supranuclear palsy (PSP). Beyond DTI, nontraditional diffusion techniques such as diffusion kurtosis imaging (DKI) have been shown to characterize brain tissue further. In this work, we aim to determine the utility of DKI in the differential diagnosis of PSP-Richardson syndrome (PSP-RS) and PSP with predominant parkinsonism (PSP-P) from Parkinson's disease (PD) and controls. METHODS: A multishell diffusion-weighted sequence was acquired at 3 Tesla on a Siemens system in 22 patients with PSP-RS, 23 with PSP-P, 19 with PD, and 19 controls. Fractional anisotropy, mean diffusivity, kurtosis fractional anisotropy (KFA), and mean kurtosis (Kmean) were calculated for nine deep gray matter regions and six different WM tracts. RESULTS: DKI identified differences (not found by DTI) between control and PSP groups in the globus pallidum externus, subthalamic region, and putamen, with Kmean in the putamen able to differentiate PSP-RS and PD. DKI WM measurements in the body of the corpus callosum and dentatorubrothalamic tract differentiated PSP-RS from PD, and the corticostriatal tract differentiated PSP-P from PD. KFA in the body of the corpus callosum identified worse microstructural anomalies in PSP-RS compared to PSP-P. DKI metrics correlated with the severity of ocular motor impairment and parkinsonism scores. CONCLUSIONS: DKI measurements could differentiate PSP-RS, PSP-P, and PD and, hence, may be a promising imaging tool for studying structural neuropathological changes in PSP.
Mediation of Multiphase Collateral Status on Functional Outcome by ASPECTS-Based Net Water Uptake in Acute Stroke.
Li Q, Bai X, Yu F … +9 more , Lu Y, Zhang M, Li J, Li Y, Tian Q, Dmytriw AA, Regenhardt RW, Jiao L, Lu J
J Neuroimaging · 2025 · PMID 40534148 · Publisher ↗
BACKGROUND AND PURPOSES: The Alberta Stroke Program Early CT Score-based net water uptake (ASPECTS-NWU) is a quantitative imaging biomarker used to assess early ischemic changes in acute ischemic stroke patients. ASPECTS...
BACKGROUND AND PURPOSES: The Alberta Stroke Program Early CT Score-based net water uptake (ASPECTS-NWU) is a quantitative imaging biomarker used to assess early ischemic changes in acute ischemic stroke patients. ASPECTS-NWU has been investigated in identifying stroke onset time, measuring ischemic tissue edema, and predicting functional outcomes. However, the mediating effect of ASPECTS-NWU and its association with collaterals, infarct volume, and functional outcome still need to be explored. Therefore, we hypothesized that ASPECTS-NWU is a mediator between collateral circulation and infarct volume and investigated their association with outcome. METHODS: There were 201 patients, and 131 of them underwent mechanical thrombectomy. Collaterals were graded using the multiphase Menon score. The mediating effect of ASPECTS-NWU between collaterals and infarct volume was investigated. The association between infarct volume, collaterals, recanalization status, and functional outcome was assessed by univariable and multivariate logistic regression analysis. RESULTS: Patients with good collaterals displayed higher ASPECTS, lower ASPECTS-NWU, lower National Institute of Health Stroke Scale score at admission (NIHSS), and smaller infarct volume, ischemic tissue volume, and penumbra volume. ASPECTS-NWU was a mediator between collaterals and infarct volume, and the contribution rate of the mediator was 27.9%. In multivariate logistic regression analysis, infarct volume and recanalization status were associated with functional outcomes. CONCLUSIONS: ASPECTS-NWU was a mediator and played a partial role between collaterals and infarct volume. Infarct volume and recanalization status were strong predictors of functional outcome. ASPECTS-NWU and collaterals indirectly influenced functional outcomes by regulating infarct volume.
Diffusion Tensor Imaging in Progressive Supranuclear Palsy Versus Other Neurodegenerative Diseases: A Review.
Giannakis A, Konitsiotis S, Xiromerisiou G
J Neuroimaging · 2025 · PMID 40524370 · Publisher ↗
Progressive supranuclear palsy (PSP) is a complex neurodegenerative disorder that is frequently misdiagnosed, largely due to its overlapping clinical features with other neurodegenerative diseases, such as Parkinson's di...
Progressive supranuclear palsy (PSP) is a complex neurodegenerative disorder that is frequently misdiagnosed, largely due to its overlapping clinical features with other neurodegenerative diseases, such as Parkinson's disease and multiple system atrophy. Accurate and early diagnosis remains a significant clinical challenge. In this context, diffusion tensor imaging (DTI), a specialized magnetic resonance imaging technique that measures the directional movement of water molecules in neural tissue, has emerged as a promising biomarker. This narrative review synthesizes current research on the utility of DTI in differentiating PSP from other neurodegenerative diseases. Multiple studies have reported significant alterations in DTI parameters-particularly fractional anisotropy and mean diffusivity-in key brain regions, including the superior cerebellar peduncle, thalamus, corticospinal tract, anterior parts of the corpus callosum, and prefrontal cortex. While classical radiological signs such as the hummingbird and Mickey Mouse signs remain highly specific for the classic Richardson syndrome (PSP-RS), superior to any results highlighted by studies of this review, in areas associated with other PSP subtypes, such as the frontal cortex, DTI has scored high rates of diagnostic accuracy, a point that could be more explored in future research efforts. Nonetheless, limitations including small sample sizes, heterogeneous study designs, and a predominant focus on the PSP-RS subtype restrict broader generalizability. Large-scale, multicenter studies are necessary to validate these findings across the diverse spectrum of PSP presentations and to establish DTI as a robust diagnostic tool.
Unified Framework for Oculomotor Nerve Reconstruction: Tractography-Based Anatomical Assessment.
Huang J, Zeng Q, Wu Y … +5 more , Zhang J, Li M, Xie L, Li M, Feng Y
J Neuroimaging · 2025 · PMID 40515422 · Publisher ↗
BACKGROUND AND PURPOSE: The oculomotor nerve (OCN) innervates the eye muscles and can be affected by inflammatory, compressive, and pathological conditions. Diffusion MRI (dMRI) tractography shows the potential ability t...
BACKGROUND AND PURPOSE: The oculomotor nerve (OCN) innervates the eye muscles and can be affected by inflammatory, compressive, and pathological conditions. Diffusion MRI (dMRI) tractography shows the potential ability to describe the trajectory of the OCN. However, reconstruction of the OCN in the cavernous sinus is still challenging due to the complex tissue environment at the skull base. METHODS: In this study, we integrated anatomical knowledge to propose a unified framework for OCN tractography, using 45 dMRI datasets from the Human Connectome Project subjects aged 22-36 years and data from four neurosurgical patients aged 41-53 years with visual behavior disorders. We first employed automatically labeled direct and indirect anatomical landmarks as reference locations for individualized tractography. Next, we compared five widely used cranial nerve reconstruction algorithms to assess the most suitable method for OCN reconstruction. Finally, we tested the combination of the unified framework and the optimized tractography method in tumor patients. RESULTS: We found that unscented Kalman filter (UKF)-2T and probabilistic tractography outperformed other methods in OCN fiber tractography, owing to their "step-by-step" fiber direction computation and multidirectional consideration, respectively. In neurosurgical patients, UKF-2T effectively reconstructed OCN fibers around lesions. CONCLUSION: Our study provides valuable insights for researchers and clinicians in the diagnosis and treatment of OCN-related diseases and neurosurgeries.
Hyperattenuating Collateral Arteries and Accompanying Cortical Veins as Auxiliary Signs of M2 Occlusion on Dual-Phase CTA.
Mortimer A, Flood R, Dunkerton S
J Neuroimaging · 2025 · PMID 40483560 · Publisher ↗
BACKGROUND AND PURPOSE: M2 middle cerebral arterial (MCA) occlusions present a greater radiological challenge when compared to more proximal occlusions and additional signs aiding detection could be helpful. We routinely...
BACKGROUND AND PURPOSE: M2 middle cerebral arterial (MCA) occlusions present a greater radiological challenge when compared to more proximal occlusions and additional signs aiding detection could be helpful. We routinely image patients with a dual-phase CT angiography (CTA) protocol, encompassing a bolus-tracked arterial/early and then delayed-phase (40-s post contrast injection) acquisition. We screened a 12-month period of our local thrombectomy database as a preliminary investigation into additional signs that can be gleaned to aid M2 occlusion diagnosis when imaged using this technique. METHODS: We reviewed the CTA and digital subtraction angiographic (DSA) imaging in 10 consecutive patients with M2 MCA occlusions who subsequently underwent thrombectomy. RESULTS: All patients showed the presence of hyperattenuating M3 and M4 vessels distal to the occlusion on delayed-phase but not early-phase CTA (despite venous opacification evident on the latter). Compared to the contralateral side, attenuation values were significantly elevated in these vessels (202.3 [23.9] vs. 108.5 [16.4] Hounsfield units [HU]; 95% confidence interval [CI] of difference: 69.7-117.9, p < 0.0001). Eight of 10 patients also showed associated ipsilateral hyperattenuating cortical veins; the attenuation difference compared to contralateral cortical veins was 263.5 (58.3) vs. 151 (16.7) HU, 95% CI: 69.0-156.0, p = 0.0005. Collateral appearance and washout were much brisker on DSA suggesting that the signs on delayed-phase CTA represent the retrograde accumulation of contrast material distal to the occlusion after multiple contrast passes with slowed resultant venous flow accounting for an accumulation on the venous side. CONCLUSION: An additional phase at 40-s displays hyperattenuating distal arteries and cortical veins that could aid in occlusion detection.
Observer Variability in CT Angiography Carotid Segmentation: Assessing Variability to Set Minimum Clinical Performance.
Boyd C, Kleinig TJ, Dawson J … +3 more , Patel S, Mayer W, Bezak E
J Neuroimaging · 2025 · PMID 40468520 · Full text
BACKGROUND AND PURPOSE: This work evaluates carotid atherosclerosis quantification from computed tomography angiography (CTA), by novice and expert human contours. Variability sources are critically assessed to establish...
BACKGROUND AND PURPOSE: This work evaluates carotid atherosclerosis quantification from computed tomography angiography (CTA), by novice and expert human contours. Variability sources are critically assessed to establish the minimum performance of future machine learning (ML) tools. METHODS: We analyzed extra cranial carotid lesions, with no, mild, moderate, and severe atherosclerosis (n = 10/group). CTA datasets of 24 patients (n = 6/group) were re-sampled to 2.5 mm axial thicknesses. Lumen, calcific plaque, and soft plaque were manually contoured by three expert experienced clinicians (neuroradiologist, vascular neurologist, and vascular surgeon), a medical physicist (MP), and a radiographer. Contouring was repeated several months later for intra-operator variability and again after development of a protocol. Clinicians blindly ranked each other's contours for descriptive statistical analysis. RESULTS: Relative to internal carotid origin, plaque began a median of 3.75 mm inferior (Interquartile Range [IQR] 0.8-7 mm), extended 18 mm superior (IQR: 13.0-29.6 mm), with a median total length of 24.4 mm (IQR: 14.7-37.4 mm). Clinicians and non-clinicians contoured lumen and calcific plaque similarly (dice similarity coefficient [DSC]: 0.87/0.62 respectively), but varied greater for soft plaque (DSC: 0.21). Neuroradiologist contours were consistently smaller, from approaching the partial-volume artifact conservatively. Clinicians favored their own contours, most pronouncedly the neuroradiologist (standard deviation: 0.00). Establishing a contouring protocol was not found to improve the agreement between clinicians. CONCLUSIONS: CTA carotid pathology contouring inherently has limited clinician agreement due to small structure size and poor contrast. The reference-contour datasets produced by experienced clinicians are prone to inter-and intra-variability which must be carefully considered to ensure ML models developed from such datasets are not fatally flawed.
Functional Brain Abnormalities in Patients With Accommodative Asthenopia: A Resting-State fMRI Study.
Lv X, Tan W, Yu Y … +5 more , Shao Y, Tao J, Miao W, Yu P, Chen Y
J Neuroimaging · 2025 · PMID 40457537 · Publisher ↗
BACKGROUND AND PURPOSE: Excessive electronic device use has intensified visual workload, resulting in accommodative asthenopia (AA). Our previous functional MRI (fMRI) studies linked abnormal brain function to AA, prompt...
BACKGROUND AND PURPOSE: Excessive electronic device use has intensified visual workload, resulting in accommodative asthenopia (AA). Our previous functional MRI (fMRI) studies linked abnormal brain function to AA, prompting this resting-state fMRI study to explore local and global brain activity changes. METHODS: We recruited 33 healthy controls and 44 patients with AA, analyzing regional brain function via coherent regional homogeneity (Cohe-ReHo) and amplitude of low-frequency fluctuation (ALFF)/fractional ALFF (fALFF). Group independent component analysis (gICA) extracted independent components (ICs) for spatial comparison, and static/dynamic functional network connectivity (sFNC/dFNC) assessed subnetwork interactions. RESULTS: Patients with AA had increased ALFF in regions of the right cerebellum 9, superior lobe of the right cerebellum, left cerebellum 8, left cerebellum 9, and left brainstem; there were negative regions in the frontal lobe (also the same area found in fALFF values) and the right postcentral gyrus. Cohe-ReHo was elevated in the inferior lobes of the bilateral cerebellum and left caudate nucleus but reduced in the left median cingulate, paracingulate gyri, and right precentral gyrus. Correlation analysis among Cohe-ReHo, ALFF/fALFF values, and asthenopia survey scores showed that the correlation had no statistical significance. The gICA revealed that the spatial distribution of ICs showed no difference. The results of sFNC and dFNC analysis showed that there was no difference. CONCLUSIONS: Patients with AA had regional brain dysfunction. In the analysis of brain subnetworks, there was no difference between the groups in terms of the spatial organization of subnetworks or the static and dynamic connectivity between subnetworks.
Cardiovascular Risk Factors Impact Brain Volume and White Matter Hyperintensities: A Multiethnic Cohort Study.
Vriend EMC, de Sitter A, Bouwmeester TA … +6 more , Franco OH, Galenkamp H, Moll van Charante EP, Collard D, Nederveen AJ, van den Born BH
J Neuroimaging · 2025 · PMID 40452126 · Full text
BACKGROUND AND PURPOSE: Brain atrophy and white matter hyperintensities (WMHs) are established markers of cerebrovascular disease, yet most evidence comes from older populations of predominantly European descent. We pros...
BACKGROUND AND PURPOSE: Brain atrophy and white matter hyperintensities (WMHs) are established markers of cerebrovascular disease, yet most evidence comes from older populations of predominantly European descent. We prospectively examined the relationship between cardiovascular risk factors and brain volumes and WMHs in middle-aged participants in a multiethnic cohort and examined ethnic differences in these associations. METHODS: Baseline data (2011-2015) were collected from 562 participants of Moroccan, South-Asian Surinamese, and Dutch descent, with 3 Tesla brain MRIs conducted between 2021 and 2022 (median follow-up 8.4 years). Brain and WMH volumes were assessed using automated segmentation of Magnetization Prepared-RApid Gradient Echo and three-dimensional Fluid-Attenuated Inversion Recovery scans. Linear regression analyses examined associations between cardiovascular risk factors and brain volumes and log-transformed WMH volumes. Interaction terms explored ethnic differences in these associations. RESULTS: Median age was 53 years, and 45% were female. Higher body mass index (BMI) and diabetes mellitus were associated with lower brain volumes (-7.6 mL per BMI unit, 95% confidence interval [CI] -12.6, -2.7; 103.4 mL for diabetes, 95% CI -167.4, -39.3). Hypertension and a history of cardiovascular disease were associated with 54.7% (95% CI 25.5, 90.7) and 98.3% (95% CI 30.9, 200.4) higher WMH volumes, respectively. Associations of diabetes with brain volume and hypertension with WMH volume were most pronounced among South-Asian Surinamese participants. CONCLUSIONS: Cardiovascular risk factors in midlife were strongly associated with brain volumes and WMHs after 8 years of follow-up. Ethnic differences in the strength of these associations underscore the importance of tailored cerebrovascular risk assessment across diverse populations.
Sustained Enlargement in Vagus and Sural Nerve Cross-Sectional Areas in Fibromyalgia: A Longitudinal Study.
Bianchi B, Cipolletta E, Farah S … +2 more , Salaffi F, Di Carlo M
J Neuroimaging · 2025 · PMID 40452122 · Full text
BACKGROUND AND PURPOSE: Fibromyalgia (FM) is a complex condition with unclear pathophysiology. While central sensitization is commonly accepted as the predominant cause of pain symptoms, numerous evidences suggest a role...
BACKGROUND AND PURPOSE: Fibromyalgia (FM) is a complex condition with unclear pathophysiology. While central sensitization is commonly accepted as the predominant cause of pain symptoms, numerous evidences suggest a role for the peripheral nervous system, particularly small fiber neuropathy. Previous studies have documented that patients with FM show an increased cross-sectional area (CSA) of some nerves, including the vagus and sural nerves, detectable via ultrasound (US). The purpose of this study is to assess whether the CSA increase persists over time and to investigate potential correlations between nerve dimensions and clinical variables. METHODS: This study involved 32 female patients with FM and 20 healthy controls, both evaluated at baseline and after 24 months. Participants completed clinimetric questionnaires addressing disease severity, neuropathic pain features, and autonomic dysfunction, while US measurements of the vagus and sural nerves' CSA were taken. Differences in CSA variation were assessed with student's t-test and chi-square, and the Pearson's correlation coefficient tested relationships between nerve dimensions and clinimetric scores. RESULTS: CSA values were higher in FM patients compared to controls at both baseline and after 24 months, although no significant differences in CSA changes were found over time. Pearson's correlation revealed some associations between nerve dimensions and clinimetric scores, suggesting potential relationships that require further investigation. CONCLUSIONS: FM patients exhibit persistent increases in the vagus and sural nerves CSAs. Further studies are needed to better understand the clinical significance of these findings and the role of US assessment as a tool for detecting nerve alterations in FM.
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