Journal Of Neuroimaging[JOURNAL]
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200 papers
Corticospinal Tract Injury Leads to Poor Motor Recovery Immediately After Ischemic Stroke.
Khan M, Gallagher L, Packard L … +3 more , Parker J, Chesla D, Heredia G
J Neuroimaging · 2025 · PMID 41069035 · Publisher ↗
BACKGROUND AND PURPOSE: Corticospinal tract (CST) integrity is an imaging biomarker for predicting upper extremity motor recovery, but data are limited in acute ischemic stroke patients. Our study aimed to assess the imp...
BACKGROUND AND PURPOSE: Corticospinal tract (CST) integrity is an imaging biomarker for predicting upper extremity motor recovery, but data are limited in acute ischemic stroke patients. Our study aimed to assess the impact of CST disruption on upper extremity motor recovery after acute ischemic stroke. METHODS: We enrolled patients with upper extremity motor deficits within 7 days of stroke onset. Patients' clinical status was assessed for the upper extremity Fugl-Meyer assessment motor component (UE-FM) within 7 days of stroke and at 15, 30, and 90 days. MRI with tractography was performed within 7 days of stroke. Diffusion tensor images (DTI) were processed to produce maps of fractional anisotropy (FA), apparent diffusion, axial, radial, and mean diffusivity. FA maps were used to assess CST asymmetry index (CST-AI). Fisher's exact tests for categorical variables, two-sample t-tests for normally distributed numerical data, and Wilcoxon rank sums for non-normally distributed numeric data were used. RESULTS: A total of 21 patients were enrolled in the study with a mean age of 66 (±14) years and median baseline upper extremity motor component score (UE-FM) of 42 (median) [range: 23, 53]. Baseline UE-FM was not predictive of a 10-point change at 90 days (p = 0.4469). CST-AI was predictive of recovery at 15 days (p = 0.0373), and axial diffusivity was predictive of recovery at 90 days (p = 0.0402). All other imaging variables did not predict recovery. CONCLUSION: Our data suggest that upper extremity motor recovery after acute ischemic stroke is impacted by CST integrity. Further studies are needed to validate our findings.
Correction to "A Novel Convolutional Neural Network for Automated Multiple Sclerosis Brain Lesion Segmentation".
J Neuroimaging · 2025 · PMID 41040041 · Full text
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Cancer Predisposition Syndromes With Involvement of the Head and Neck Regions in Children: An Imaging Guide.
Mertiri L, Desai N, Lequin M … +6 more , Mertiri D, Tran HB, Alves C, Chiocchi M, Huisman TAGM, D'Arco F
J Neuroimaging · 2025 · PMID 41029896 · Publisher ↗
Cancer predisposition syndromes (CPSs) are a group of inherited disorders that significantly increase the risk of developing various cancers, ranging from infancy through adulthood. CPSs account for about 10% of the pedi...
Cancer predisposition syndromes (CPSs) are a group of inherited disorders that significantly increase the risk of developing various cancers, ranging from infancy through adulthood. CPSs account for about 10% of the pediatric cancers, and they represent a major cause of morbidity and mortality in affected children. The inheritance pattern and the variable penetrance influence the age of onset and the clinical course, resulting in substantial variation in presentation, even within a single family. Early recognition of CPSs is crucial, as timely diagnosis allows for health surveillance, preventive interventions, and genetic counselling for patients and their families. Guidelines and surveillance programs have been developed to identify at-risk patients and coordinate long-term care. This review focuses on the most common CPSs associated with pediatric cancers, with particular emphasis on the involvement of the head and neck region. For each syndrome, we provide a background summary including its genetics and clinical manifestations, followed by a detailed description of characteristic head and neck imaging findings. Illustrative case examples are then presented to demonstrate the spectrum of clinical and imaging features. It highlights imaging features to assist providers reading these studies in the early identification of all possible pathological manifestations in these syndromes. Key CPSs covered include retinoblastoma, Li-Fraumeni syndrome, neurofibromatosis type 1, DICER1 syndrome, rhabdoid tumor predisposition syndrome, Gorlin-Goltz syndrome, hereditary paraganglioma-pheochromocytoma syndrome, constitutional mismatch repair deficiency syndrome, and neuroblastoma predisposition syndrome.
Prolonged Venous Transit Is Associated With Unfavorable Outcomes in Anterior Circulation Distal Medium Vessel Stroke.
Salim HA, Lakhani DA, Balar A … +19 more , Shahriari M, Sriwastawa A, Cho A, Dmytriw AA, Guenego A, Marsh EB, Lu H, Xu R, Leigh R, Shah G, Wen S, Albers GW, Hillis AE, Llinas R, Nael K, Wintermark M, Heit JJ, Faizy TD, Yedavalli VS
J Neuroimaging · 2025 · PMID 40977128 · Full text
BACKGROUND AND PURPOSE: Distal medium-vessel occlusion (DMVO) strokes represent a significant proportion of acute ischemic stroke cases, yet optimal management remains unclear. Prolonged venous transit (PVT), a marker of...
BACKGROUND AND PURPOSE: Distal medium-vessel occlusion (DMVO) strokes represent a significant proportion of acute ischemic stroke cases, yet optimal management remains unclear. Prolonged venous transit (PVT), a marker of poor venous outflow, has been associated with worse outcomes in large-vessel occlusion strokes, but its role in DMVO is unknown. METHODS: In a retrospective study, consecutive patients with anterior-circulation DMVO, defined as occlusions in the M2-M4 segments of the middle cerebral artery or the anterior cerebral artery. PVT status was determined on pretreatment time-to-maximum perfusion maps by identifying ≥10-s delays in either the posterior superior sagittal sinus or the torcula. Baseline characteristics, imaging findings, and interventions were collected. The primary outcome was a 90-day modified Rankin Scale (mRS) score of 0-2. RESULTS: Among 77 patients (median age 70 years, 56% female), 18 (23%) had PVT. Median admission National Institutes of Health Stroke Scale scores were 11 (interquartile range, 7-15), and intravenous thrombolysis was administered to 35% of patients. Patients with PVT+ were less likely to achieve mRS 0-2 at 90 days (adjusted odds ratio, 0.14; 95% confidence interval, 0.02-0.85; p = 0.046). There were no significant differences in rates of hemorrhagic transformation or mortality. CONCLUSIONS: PVT is independently associated with unfavorable functional outcomes in anterior-circulation DMVO. These findings suggest PVT may serve as a prognostic indicator and could inform treatment decisions in this challenging stroke subtype.
Spinal and Sacral Chordomas: Overview With Imaging Review.
Choi R, Schick J, Manupipatpong S … +6 more , Law S, Gross J, Xia Y, Lubelski D, Redmond KJ, Khan M
J Neuroimaging · 2025 · PMID 40955127 · Publisher ↗
Spinal chordomas are rare, malignant bone tumors originating from notochordal remnants, primarily affecting the sacrum, clivus, and spine. Despite their low prevalence, they present significant diagnostic and therapeutic...
Spinal chordomas are rare, malignant bone tumors originating from notochordal remnants, primarily affecting the sacrum, clivus, and spine. Despite their low prevalence, they present significant diagnostic and therapeutic challenges due to their local aggressiveness, high recurrence rate, and imaging similarities to other tumors, such as chondrosarcomas. Advances in imaging technologies, particularly high-resolution magnetic resonance imaging and computed tomography (CT), have improved the ability to visualize chordomas and enhance the precision of surgical planning. Additionally, newer imaging modalities, including diffusion-weighted imaging and positron emission tomography/CT, offer more refined diagnostic capabilities, though differentiation from other similar lesions remains difficult. Histologically, chordomas are marked by physaliphorous cells and a myxoid stroma, with the brachyury gene playing a key role in tumorigenesis and serving as a potential therapeutic target. The pathophysiology and molecular landscape of chordomas further complicate diagnosis and treatment. This review examines the current state of imaging advancements, challenges in diagnosis, and their impact on clinical management. It highlights the importance of combining various imaging modalities to improve diagnostic accuracy, aid surgical resection planning, and reduce recurrence. Additionally, it discusses the ongoing need for more targeted therapies and improved imaging techniques to optimize patient outcomes in spinal chordoma management.
Association of Spinal Cord Radiomic Features and Disability in Multiple Sclerosis.
Lambe J, Thompson NR, Li Y … +2 more , Nakamura K, Ontaneda D
J Neuroimaging · 2025 · PMID 40947502 · Full text
BACKGROUND AND PURPOSE: Spinal cord pathology underpins disability accumulation in people with multiple sclerosis (pwMS). Visual inspection of spinal cord magentic resonance imaging (MRI) often fails to reliably detect i...
BACKGROUND AND PURPOSE: Spinal cord pathology underpins disability accumulation in people with multiple sclerosis (pwMS). Visual inspection of spinal cord magentic resonance imaging (MRI) often fails to reliably detect injury. Radiomics analyzes signal intensities in images to identify pathological changes that may be imperceptible to the human eye. This study evaluated the application of radiomics to spinal cord MRI to distinguish subgroups of pwMS and disability correlations. METHODS: Radiomic features were extracted from upper cervical cord coverage on cross-sectional 3.0T brain noncontrasted T1-weighted MRI scans in pwMS and healthy controls (HCs). Ninety-three radiomic features-predominantly gray-level matrices-were extracted using Pyradiomics, with pixel heterogeneity considered to reflect neuroaxonal pathology. T2 lesion and brain substructure volumes were segmented from 3D fluid-attenuated inversion recovery and magnetization-prepared rapid gradient-echo sequences using an in-house 2.5D U-Net convolutional neural network to encapsulate neuroinflammation and neurodegeneration. Cervical cross-sectional area (C1-C3) was measured using in-house atlas-based segmentation. Imaging features were compared between pwMS and HCs, and pwMS by phenotype (relapsing vs. progressive), age, and race. Associations of imaging features with Patient-Determined Disease Steps (PDDS) were examined. RESULTS: Among 2966 pwMS and 41 HCs, we identified radiomic features distinguishing pwMS from HCs, and pwMS by phenotype, age, and race. Radiomic features exhibited stronger correlations with PDDS than conventional MRI measures. CONCLUSIONS: Radiomics identified pathological changes in pwMS in varying stages of the disease course that are undetectable by conventional spinal cord MRI. Radiomics may increase the yield of spinal cord MRI in pwMS and serve as biomarkers predicting disability worsening.
Multivariate Pattern Analysis of Perfusion and Oxygenation Impairment in Asymptomatic Carotid Artery Stenosis.
Kufer J, Preibisch C, Göttler J … +6 more , Schmitzer L, Hoffmann G, Kallmayer M, Zimmer C, Hyder F, Kaczmarz S
J Neuroimaging · 2025 · PMID 40947496 · Full text
BACKGROUND AND PURPOSE: Hemodynamic impairment may contribute to stroke risk and cognitive decline in asymptomatic internal carotid artery stenosis (ICAS). Therefore, multimodal MRI-based quantification of hemodynamic im...
BACKGROUND AND PURPOSE: Hemodynamic impairment may contribute to stroke risk and cognitive decline in asymptomatic internal carotid artery stenosis (ICAS). Therefore, multimodal MRI-based quantification of hemodynamic impairment could inform improved treatment decisions. While gross interhemispheric hemodynamic imbalances have been reported in ICAS, identifying more spatially resolved patterns of disease-related alterations may be promising to harness the full potential of hemodynamic MRI. METHODS: In this feasibility study, we investigated the spatial topography of ICAS-related impairments by applying scaled subprofile model principal component analysis (SSM-PCA) to cerebral blood flow (CBF), relative oxygen extraction fraction (rOEF), and oxygen extraction capacity (OEF) data of 21 unilateral ICAS patients and 25 healthy controls (HC). RESULTS: We found spatially extended, partly overlapping disease-related patterns for CBF and OEF, but not rOEF. CBF (area under the curve [AUC] = 0.95) but not OEF (AUC = 0.72) SSM-PCA scores distinguished ICAS patients and HC better than interhemispheric lateralizations (AUC = 0.75/0.73). SSM-PCA scores were only partly explained by interhemispheric lateralization (R = -0.27/0.38), indicating complementary information. Critically, ICAS patients with higher OEF SSM-PCA scores (z ≥ 1) demonstrated higher stenotic degrees and lower cognitive performance (p < 0.05) without differing in interhemispheric lateralization (p > 0.05). CONCLUSIONS: We demonstrated the feasibility of SSM-PCA in ICAS and obtained novel insights into complex hemodynamic impairment patterns and their association with cognitive function.
A Novel Convolutional Neural Network for Automated Multiple Sclerosis Brain Lesion Segmentation.
Dereskewicz E, La Rosa F, Dos Santos Silva J … +14 more , Sizer E, Kohli A, Wynen M, Mullins WA, Maggi P, Levy S, Onyemeh K, Ayci B, Solomon AJ, Assländer J, Al-Louzi O, Reich DS, Sumowski J, Beck ES
J Neuroimaging · 2025 · PMID 40937688 · Full text
BACKGROUND AND PURPOSE: Assessment of brain lesions on magnetic resonance imaging (MRI) is crucial for research in multiple sclerosis (MS). Manual segmentation is time-consuming and inconsistent. We aimed to develop an a...
BACKGROUND AND PURPOSE: Assessment of brain lesions on magnetic resonance imaging (MRI) is crucial for research in multiple sclerosis (MS). Manual segmentation is time-consuming and inconsistent. We aimed to develop an automated MS lesion segmentation algorithm for T2-weighted fluid-attenuated inversion recovery (FLAIR) MRI. METHODS: We developed FLAIR Lesion Analysis in Multiple Sclerosis (FLAMeS), a deep learning-based MS lesion segmentation algorithm based on the nnU-Net 3D full-resolution U-Net and trained on 668 FLAIR 1.5 and 3 tesla scans from persons with MS. FLAMeS was evaluated on three external datasets: MSSEG-2 (n = 14), MSLesSeg (n = 51), and a clinical cohort (n = 10), and compared to SAMSEG, LST-LPA, and LST-AI. Performance was assessed qualitatively by two blinded experts and quantitatively by comparing automated and ground truth lesion masks using standard segmentation metrics. RESULTS: In a blinded qualitative review of 20 scans, both raters selected FLAMeS as the most accurate segmentation in 15 cases, with one rater favoring FLAMeS in two additional cases. Across all testing datasets, FLAMeS achieved a mean Dice score of 0.74, a true positive rate of 0.84, and an F1 score of 0.78, consistently outperforming the benchmark methods. For other metrics, including positive predictive value, relative volume difference, and false positive rate, FLAMeS performed similarly to or better than benchmark methods. Most lesions missed by FLAMeS were smaller than 10 mm, whereas the benchmark methods missed larger lesions in addition to smaller ones. CONCLUSIONS: FLAMeS is an accurate, robust method for MS lesion segmentation that outperforms other publicly available methods.
Intraindividual Optic Nerve Sheath Variation and Intracranial Pressure Changes: A Systematic Review and Meta-Analysis.
Azevedo H, Neto LL, Berhanu D
J Neuroimaging · 2025 · PMID 40916062 · Full text
BACKGROUND AND PURPOSE: To review the existing evidence on multiple timepoint assessments of optic nerve sheath diameter (ONSD) as an indicator of intraindividual variation of intracranial pressure (ICP). METHODS: A syst...
BACKGROUND AND PURPOSE: To review the existing evidence on multiple timepoint assessments of optic nerve sheath diameter (ONSD) as an indicator of intraindividual variation of intracranial pressure (ICP). METHODS: A systematic search identified studies assessing intraindividual variation in ICP through multiple timepoint measurements of ONSD using ultrasonography. Meta-analysis of studies assessing intraindividual correlation coefficients between ONSD and ICP was performed using a random effects model, and we calculated the weighted correlation coefficient for the expected change in ICP associated with variations in ONSD. RESULTS: A total of five studies, comprising 157 patients, were included in the review. ONSD was compared with invasive ICP measurement methods at multiple timepoints. Meta-analysis of intraindividual ONSD-ICP correlation demonstrated a correlation coefficient of 0.62 (CI: 0.50-0.71). Individual linear correlation analyses were performed in two of the studies, yielding correlation coefficients ranging from 0.79 to 1.00; however, widely variable individual slopes were found (1.51-41.43 mm/mmHg). ONSD variations ranged from 0.12 to 3.30 mm per 5 mmHg change in ICP, with a variation of 0.55 mm in adults with hypoxic brain injury and 0.77 mm in children with idiopathic intracranial hypertension. CONCLUSIONS: Our findings indicate that ONSD significantly correlates with ICP, and longitudinal intraindividual assessment shows a predominantly linear correlation between both variables. A personalized ONSD-ICP correlation equation may enable accurate ICP prediction, making ONSD a useful tool for follow-up in patients with previous invasive ICP measurements, when adjusted to each patient's characteristics and pathologies.
Impact of Childhood Neighborhood Deprivation on White Matter and Functional Connectivity During Adolescence.
Acosta-Rodriguez H, Bobba P, Stephan A … +6 more , Zeevi T, Malhotra A, Tran AT, Kaltenhauser S, Ment L, Payabvash S
J Neuroimaging · 2025 · PMID 40916058 · Full text
BACKGROUND AND PURPOSE: Socioeconomic determinants of health impact childhood development and adult health outcomes. One key aspect is the physical environment and neighborhood where children live and grow. Emerging evid...
BACKGROUND AND PURPOSE: Socioeconomic determinants of health impact childhood development and adult health outcomes. One key aspect is the physical environment and neighborhood where children live and grow. Emerging evidence suggests that neighborhood deprivation, often measured by the Area Deprivation Index (ADI), may influence neurodevelopment, but longitudinal and multimodal neuroimaging analyses remain limited. METHODS: We examined the association between childhood neighborhoods and brain white matter (WM) microstructural integrity using a large, demographically representative cohort from the Adolescent Brain Cognitive Development Study. We analyzed the relationship between ADI and MRI metrics of WM microstructural integrity and resting-state funtional magnetic resonance imaging (rs-fMRI) connectivity in children with data at baseline (mean age of 9.9 years) and follow-up (mean age 12.0 years), with a sample size of n = 2615. RESULTS: Children living in poorer neighborhoods (higher ADI) showed lower brain WM microstructural integrity at baseline and follow-up, even after adjusting for age, sex, race/ethnicity, head size, body mass index, parental education, and income levels. This reduced microstructure was seen in critical tracts, such as the superior longitudinal fasciculus, corpus callosum, and the uncinate. Additionally, baseline and follow-up rs-fMRI analysis revealed that children living in poorer neighborhoods had decreased connectivity within the retrosplenial-temporal network and between higher-order networks, such as the cingulo-opercular network. CONCLUSIONS: These findings highlight the influence of neighborhood socioeconomic disadvantage on both WM microstructural integrity and functional brain connectivity in the preadolescent brain. Children from more deprived neighborhoods showed reduced integrity in key WM tracts and disrupted connectivity within and between higher-order networks.
Reliability and Spatial Consistency of MR Diffusion Tensor Imaging Measures Along the Cerebral Perivascular Space.
Qiu E, Chaganti J, Phan P … +7 more , Alizadeh M, Middleton D, Talekar K, Mondel PK, Faro SH, Mohamed FB, Yuan H
J Neuroimaging · 2025 · PMID 40903913 · Full text
BACKGROUND AND PURPOSE: Diffusion tensor imaging analysis along the perivascular space (DTI-ALPS) has emerged as a promising noninvasive method for evaluating water motion that may reflect glymphatic system function. How...
BACKGROUND AND PURPOSE: Diffusion tensor imaging analysis along the perivascular space (DTI-ALPS) has emerged as a promising noninvasive method for evaluating water motion that may reflect glymphatic system function. However, the reliability of DTI-ALPS measurements across different region-of-interest (ROI) selection methods remains underinvestigated. This study aimed to assess the interrater reliability among three neuroradiologists in native space and compare DTI-ALPS indices derived from ROIs placed in subjects' native space versus standardized Montreal Neurological Institute (MNI) space. METHODS: DTI-ALPS indices from 16 healthy subjects were calculated from both left and right hemispheres using two ROI placement approaches: (1) native space ROIs manually placed by three neuroradiologists, and (2) standardized ROIs in MNI space based on the fractional anisotropy template. Interrater reliability was assessed using intraclass correlation coefficients (ICCs). The proportion of ROI overlaps among the three neuroradiologists was also evaluated. Differences between native and MNI space measurements were evaluated using related-samples Friedman's analysis with post hoc pairwise comparisons. RESULTS: Interrater reliability for native space ROI placement was moderate for left-sided DTI-ALPS indices (ICC = 0.599) and good for right-sided DTI-ALPS indices (ICC = 0.807). Spatial overlap analysis revealed poor Dice similarity coefficients across all ROI types (range: 0.047-0.312), with right association ROIs showing higher spatial consistency. Significant differences were found between native and MNI space measurements for left-sided DTI-ALPS indices (p = 0.002) but not for right-sided DTI-ALPS indices (p = 0.913). CONCLUSION: These findings highlight the importance of standardized ROI selection approaches for clinical applications of DTI-ALPS.
Lesion-Based Disconnectome Explains Cognitive Outcomes in Multiple Sclerosis.
Dos Santos Silva J, Vasconcelos CCF, Spedo CT … +6 more , Azevedo CA, Lopes LCS, La Rosa F, Moura CB, Nascimento O, Lopes FCR
J Neuroimaging · 2025 · PMID 40898881 · Full text
BACKGROUND AND PURPOSE: Cognitive impairment is common and disabling in multiple sclerosis (MS), yet poorly explained by lesion burden. This study aimed to determine whether the indirect impact of lesions, quantified thr...
BACKGROUND AND PURPOSE: Cognitive impairment is common and disabling in multiple sclerosis (MS), yet poorly explained by lesion burden. This study aimed to determine whether the indirect impact of lesions, quantified through disconnectomes, explains multidomain cognitive deficits more effectively than lesion load, and to identify specific white matter tracts underlying these deficits. METHODS: Thirty adults with MS completed the Brief International Cognitive Assessment for MS, covering processing speed (Symbol Digit Modalities Test; SDMT), verbal memory (California Verbal Learning Test-II; CVLT-II), and visuospatial memory (Brief Visuospatial Memory Test-Revised; BVMT-R). Lesions were segmented using 3 Tesla fluid-attenuated inversion recovery images and used to estimate tract-specific disconnections and generate voxel-wise disconnectome maps. Tract-specific and voxel-wise analyses were used to identify disconnection patterns associated with cognitive performance. RESULTS: Cognition was impaired across all domains (all p < 0.001). Disconnectome volume was a significant independent determinant of cognitive performance (β = -0.41, p = 0.004), whereas lesion volume was not. Tract-specific analyses revealed distinct disconnection patterns: slower SDMT was associated with left cingulum posterior (β = -0.310, 95% confidence interval [CI] [-0.599, -0.021]); poorer CVLT-II with left arcuate fasciculus (β = -0.232, 95% CI [-0.435, -0.030]); and lower BVMT-R with right cingulum posterior (β = -0.218, 95% CI [-0.383, -0.054]). Voxel-wise analyses identified where the strongest associations between disconnectomes and cognitive performance were located. CONCLUSION: Lesion-driven disconnection is a more robust determinant of cognitive impairment in MS than lesion burden alone, and disconnectome mapping may help understand the indirect network-level mechanisms underlying cognitive deficits in MS.
Functional Imaging in Alzheimer's Disease: A Systematic Review and Meta-Analysis of ASL-MRI and FDG-PET.
Radmard M, Gad M, Sheikhy A … +3 more , Dagher R, Yedavalli V, Luna LP
J Neuroimaging · 2025 · PMID 40898829 · Publisher ↗
BACKGROUND: Alzheimer's disease (AD) and mild cognitive impairment (MCI) are two common conditions associated with cognitive decline. With global dementia cases rising, identifying the most accurate imaging method for di...
BACKGROUND: Alzheimer's disease (AD) and mild cognitive impairment (MCI) are two common conditions associated with cognitive decline. With global dementia cases rising, identifying the most accurate imaging method for diagnosis is essential. METHODS: Following Preferred Reporting Items for Systematic review and Meta-Analysis Protocols, we systematically reviewed studies utilizing arterial spin labeling magnetic resonance imaging (ASL-MRI) and [18F]-2-fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET) for neurodegenerative disorders. Searches in PubMed/MEDLINE, Scopus, and Embase led to 17 studies directly comparing these modalities for MCI/AD diagnosis. Seven studies met criteria for meta-analysis based on interreader agreement and area under the curve (AUC) data. Meta-analysis was performed using the R "Mada" package, with study heterogeneity assessed via the Zhou and Dendukuri approach. RESULTS: Meta-analysis of seven studies showed FDG-PET had a slightly higher AUC (0.864, sensitivity 0.81, specificity 0.80) compared to ASL-MRI (AUC 0.836, sensitivity 0.73, specificity 0.80), but no statistically significant difference. Low heterogeneity was observed (I: 9.4% for FDG-PET, 6.5% for ASL-MRI). In MCI subgroup analysis, FDG-PET outperformed ASL-MRI with significantly higher sensitivity (0.90 vs. 0.75), specificity (0.91 vs. 0.73), and AUC (0.92 vs. 0.80, p < 0.001). CONCLUSION: FDG-PET and ASL-MRI demonstrate comparable diagnostic accuracy for AD and MCI. Selection between modalities may depend on availability, cost, and safety considerations. CLINICAL RELEVANCE/APPLICATION: Both FDG-PET and MRI-ASL are effective at identifying MCI and AD, enabling accurate diagnosis. The choice of which modality to use may be addressed by cost, availability, and consideration of other potential diagnoses.
Characterizing Hemodynamic Alterations in Glioma: Insights From Resting-State Functional MRI.
Kanzawa J, Amemiya S, Takao H … +1 more , Abe O
J Neuroimaging · 2025 · PMID 40898809 · Full text
BACKGROUND AND PURPOSE: This study aims to characterize hemodynamic alterations in gliomas by analyzing global signal metrics and amplitude of low-frequency fluctuations (ALFF). METHODS: We analyzed resting-state functio...
BACKGROUND AND PURPOSE: This study aims to characterize hemodynamic alterations in gliomas by analyzing global signal metrics and amplitude of low-frequency fluctuations (ALFF). METHODS: We analyzed resting-state functional MRI data from an open dataset. A total of 29 glioma patients (17 men; mean age: 44.2 ± 13.9 years; 16 high-grade) were included. Global signal cross-correlation (GSXC), representing the maximum cross-correlation value between each voxel's time series and the average gray matter signal of the contralateral hemisphere, and ALFF were calculated. Regions of interest for tumor were defined and mirrored to the contralateral side for comparison. Linear mixed-effects models were used to examine effects of tumor grade and measurement side on GSXC and ALFF. Post hoc analyses compared tumor versus contralateral regions. RESULTS: GSXC was significantly reduced in tumor regions compared to the contralateral hemisphere, regardless of tumor grade (low-grade: 0.31 ± 0.21 vs. 0.45 ± 0.16, p = 0.005; high-grade: 0.39 ± 0.17 vs. 0.55 ± 0.13, p < 0.001). ALFF was significantly lower in low-grade tumors compared to the contralateral side (0.65 ± 0.15 vs. 0.77 ± 0.14, p = 0.005), while no significant difference was found in high-grade tumors (0.80 ± 0.18 vs. 0.77 ± 0.10, p = 0.46). CONCLUSIONS: Our findings suggest that GSXC and ALFF provide complementary pathological information on glioma. GSXC indicates impaired cerebrovascular reactivity due to gliovascular uncoupling, whereas ALFF shows an increase in high-grade gliomas likely reflecting greater total vascularity.
Tandem Cervical Internal Carotid Artery Hyperdensity Implies Stent Reocclusion on Post Thrombectomy Computed Tomography.
Mortimer A, Mohamed W, Flood R … +1 more , Buddha S
J Neuroimaging · 2025 · PMID 40874687 · Publisher ↗
BACKGROUND AND PURPOSE: Acute tandem internal carotid artery (ICA) reocclusion after stenting as part of endovascular stroke treatment is recognized as a complication in a significant minority of patients, and this can b...
BACKGROUND AND PURPOSE: Acute tandem internal carotid artery (ICA) reocclusion after stenting as part of endovascular stroke treatment is recognized as a complication in a significant minority of patients, and this can be associated with neurological deterioration and worse functional outcomes. Non-contrast CT (NCCT) forms the basis of initial follow-up imaging in this setting. We aimed to assess the sensitivity and specificity of asymmetrical hyperdensity within the superior cervical ICA (HD-CICA) on cranial NCCT for tandem ICA reocclusion. METHODS: This was a retrospective review of a prospectively acquired database (of cases performed January 2022-December 2024 inclusive) at a regional thrombectomy center. The frequency of HD-CICA on 12-24 h NCCT was compared to contemporaneous vascular imaging (CT angiography or carotid Doppler ultrasound) in patients with patent and reoccluded ICAs. RESULTS: A total of 148 patients underwent thrombectomy with ICA stenting for tandem occlusion. Stent occlusion was associated with lower rates of early neurological improvement and reperfusion and higher rates of neurological deterioration. A total of 99 patients were acutely investigated for stent patency, and HD-CICA was assessable in 92. The frequency of HD-CICA with stent occlusion was 18/19 (94.7%) versus 0/73 (0%) in patent stents (p < 0.0001). HD-CICA was both a sensitive (18/19, 94.7%, 95% confidence interval: 74.0%-99.9%) and specific sign (73/73, 100%, 95% confidence interval: 95.1%-100%), with high positive and negative predictive value for stent reocclusion. CONCLUSION: HD-CICA on acute follow-up cranial NCCT is a reliable acute marker of tandem carotid reocclusion.
High Multiband Acceleration Degrades Resting-State Functional MRI Reliability and Signal Quality Under Anesthesia.
Hassanzadeh M, Ailion A, Warfield SK … +4 more , Gholipour T, Siddiqi S, Stufflebeam SM, Hassanzadeh E
J Neuroimaging · 2025 · PMID 40848013 · Publisher ↗
BACKGROUND AND PURPOSE: Resting-state fMRI (rs-fMRI) is increasingly used to map brain networks in patients under anesthesia, but technical factors can affect its utility. We evaluated the effects of sevoflurane, multiba...
BACKGROUND AND PURPOSE: Resting-state fMRI (rs-fMRI) is increasingly used to map brain networks in patients under anesthesia, but technical factors can affect its utility. We evaluated the effects of sevoflurane, multiband acceleration, and scan duration on rs-fMRI signal quality and within-subject reliability under anesthesia. METHODS: We retrospectively analyzed 64 clinical rs-fMRI scans acquired under anesthesia, with or without sevoflurane and multiband factor 5 acceleration. Temporal signal-to-noise ratio (tSNR) was used as a measure of signal quality. For each patient, the scan was split in half, and seed-based connectivity maps were generated for the primary motor cortex (M1), posterior cingulate cortex (PCC), and subgenual anterior cingulate cortex (sgACC). Split-half spatial correlations were used to assess within-subject reliability. Group comparisons examined differences in tSNR and reliability across conditions, and correlations with scan duration were tested. RESULTS: Multiband acceleration was associated with significantly lower tSNR (U = 652.0, p = 8.9 × 10─) and reduced split-half reliability for M1 (p = 0.019), PCC (p = 0.010), and sgACC (p = 0.0064). Sevoflurane showed no significant effect on tSNR or reliability. Longer scan duration correlated with improved reliability for M1 (r = 0.38, p = 0.003) but not for PCC or sgACC. No correlation was found between tSNR and reliability. CONCLUSION: Hight multiband acceleration reduces both signal quality and reliability of rs-fMRI under anesthesia. Sevoflurane had no measurable effect. The lack of correlation between tSNR and reliability underscores the need for more robust metrics when evaluating scan quality.
Atypical Edema in Posterior Reversible Encephalopathy Syndrome: Clinical Associations and Outcome.
McClelland AC, Ellis CA, Kuo E … +3 more , Ye KQ, Balu R, Mohan S
J Neuroimaging · 2025 · PMID 40824279 · Publisher ↗
BACKGROUND AND PURPOSE: Posterior reversible encephalopathy syndrome (PRES) is a neurotoxic state with characteristic imaging findings. While classic PRES typically involves parieto-occipital edema, atypical cases presen...
BACKGROUND AND PURPOSE: Posterior reversible encephalopathy syndrome (PRES) is a neurotoxic state with characteristic imaging findings. While classic PRES typically involves parieto-occipital edema, atypical cases present with variable involvement of deep gray nuclei, brainstem, cerebellum, and corpus callosum, which may complicate diagnosis. This study aims to characterize the neuroimaging features of "atypical" PRES in a large cohort and evaluate relationships with clinical variables and outcomes. METHODS: We retrospectively analyzed neuroimaging data from patients diagnosed with PRES, identifying cases with atypical edema patterns. Relationships between MRI findings, clinical variables, and outcomes were assessed with univariable and multivariable regression analyses. RESULTS: A total of 184 PRES cases were analyzed. 71.7% had "atypical" imaging findings. Atypical edema was associated with older age (odds ratio [OR] 2.96 ≥52 years, p = 0.002) and negatively associated with pregnancy (OR 0.20, p<0.001). These associations were seen in a subset of atypical locations, particularly those supplied by the posterior circulation. Additionally, certain atypical edema patterns were correlated with prolonged hospital stays and reduced clinical reversibility, suggesting a potential impact on patient outcomes. CONCLUSION: In this large series of PRES cases, atypical imaging findings were common. Atypical edema, including a posterior circulation pattern, was seen more commonly in older patients, less commonly in pregnancy, and may represent a more severe form of this syndrome with worse outcomes. Recognizing these atypical imaging patterns is crucial for timely intervention and improved patient outcomes.
Advances in Collateral Neuroimaging for Acute Ischemic Stroke: Redefining Time and Tissue Windows in the Reperfusion Era.
Mondal R, Deb S, Ray N … +6 more , Sengupta A, Sarkar V, Banerjee S, Mukherjee A, Roy J, Benito-León J
J Neuroimaging · 2025 · PMID 40820581 · Full text
Cerebral collateral circulation is a critical determinant of infarct evolution, therapeutic response, and clinical outcomes in patients with acute ischemic stroke. While the concept of "time is brain" has traditionally g...
Cerebral collateral circulation is a critical determinant of infarct evolution, therapeutic response, and clinical outcomes in patients with acute ischemic stroke. While the concept of "time is brain" has traditionally guided reperfusion therapy, recent evidence-particularly from trials like DAWN and DEFUSE 3-suggests that collateral status more accurately determines the rate of infarct progression and the extent of salvageable tissue. This comprehensive review synthesizes advances in neuroimaging modalities for evaluating cerebral collaterals, emphasizing their role in refining stroke diagnosis, guiding patient selection, and informing personalized treatment strategies. Structural approaches such as multiphase and dynamic CT angiography, alongside perfusion-based parameters (e.g., cerebral blood volume, hypoperfusion intensity ratio, and Tmax delay maps), are examined. Cortical venous outflow, assessed via the cortical vein opacification score, emerges as an independent predictor of outcome, complementing arterial grading. Susceptibility-weighted imaging, arterial spin labeling, and metabolic and molecular techniques (e.g., PET imaging of inflammation and vascular remodeling) offer functional insights beyond traditional angiography. Biomarkers such as matrix metalloproteinase-9, integrin αvβ3, and translocator protein-targeted PET ligands are discussed in relation to collateral vessel dynamics. Finally, we explore the integration of genetically informed brain atlases, spatial transcriptomics, and imaging-genomic platforms for high-resolution collateral phenotyping. Although promising, these modalities face challenges related to heterogeneity, limited validation, and the lack of standardization. A biologically informed, multimodal, and automated imaging paradigm may herald a new era of precision stroke medicine.
Optic Nerve Sheath Diameter: Which Axis Should Be Measured?
Pansell J, Thomsson T, Eng E … +2 more , Wallin A, Hirzallah M
J Neuroimaging · 2025 · PMID 40754891 · Full text
BACKGROUND AND PURPOSE: Optic nerve sheath diameter (ONSD) measured by point-of-care ultrasound (POCUS) is a commonly used non-invasive estimate of intracranial pressure (ICP). However, methodological variations limit st...
BACKGROUND AND PURPOSE: Optic nerve sheath diameter (ONSD) measured by point-of-care ultrasound (POCUS) is a commonly used non-invasive estimate of intracranial pressure (ICP). However, methodological variations limit standardization of this promising technique. Different imaging axes are identified as one such source of ONSD POCUS methodological variation. This study aimed to evaluate the agreement and diagnostic accuracy for elevated ICP between transverse and sagittal ONSD measurements. METHODS: We conducted a post-hoc analysis of 213 intensive care patients from three prior studies. ONSD was measured in both transverse and sagittal planes, externally (ONSDext) and internally (ONSDint) of the dura mater. Agreement was assessed using Lin's concordance correlation coefficient (CCC). Diagnostic accuracy for detecting ICP ≥20 mmHg was evaluated using area under the receiver operator characteristics curve (AUROC) analyses in a subset of 139 patients. RESULTS: Sagittal ONSD was significantly larger than transverse ONSD (median difference 0.2 mm, p<0.001). Agreement between transverse and sagittal ONSD was poor (CCC: 0.65 and 0.70 for right and left side ONSDext, and 0.43 and 0.51 for right and left side ONSDint). No significant differences in AUROC were found between transverse, sagittal, or averaged measurements. CONCLUSIONS: Transverse and sagittal ONSD measurements are not interchangeable due to significant differences and poor agreement. Diagnostic accuracy was similar across methods. These findings support continued use of transverse measurement as the standard approach for ONSD POCUS in clinical practice.
SPECT Cerebral Perfusion Patterns in Isolated Cervical Dystonia.
Kim B, Yoo ID, Jeong HS … +2 more , Chung YA, Song IU
J Neuroimaging · 2025 · PMID 40754885 · Full text
BACKGROUND AND PURPOSE: Isolated cervical dystonia is characterized by sustained or intermittent neck movements caused by involuntary muscle contractions, resulting in abnormal movements or postures of cervical areas. We...
BACKGROUND AND PURPOSE: Isolated cervical dystonia is characterized by sustained or intermittent neck movements caused by involuntary muscle contractions, resulting in abnormal movements or postures of cervical areas. We measured altered regional cerebral blood flow (rCBF) in patients with idiopathic cervical dystonia compared to healthy controls and explored the correlation between dystonia severity and rCBF patterns. METHODS: A total of 38 patients with isolated cervical dystonia and 29 healthy controls were recruited. All subjects underwent Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) and Tc-99m HMPAO SPECT; TWSTRS was used to assess the severity of dystonia. rCBF was compared between groups using voxel-wise statistical analyses. Associations between rCBF in significant clusters and TWSTRS scores were examined using linear regression. RESULTS: Compared with controls, patients with cervical dystonia exhibited reduced rCBF in brain regions implicated in sensory processing, motor control, and higher cognitive functions, including the left middle temporal gyrus, right postcentral gyrus, right lingual gyrus, left precuneus, right temporal pole, right middle cingulate gyrus, and right anterior cingulate gyrus. Although reduced rCBF was observed in seven regions, only the right temporal pole showed a significant correlation with TWSTRS motor scores. Reduced rCBF in the right temporal pole negatively correlated with higher TWSTRS scores in dystonia patients. CONCLUSION: The negative correlation between reduced rCBF in the right temporal pole and increased TWSTRS scores highlights a potential association between altered cerebral perfusion and dystonic symptom severity. Understanding these alterations could offer insights into the neurobiological basis of cervical dystonia, aiding targeted therapeutic interventions.
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