Dual Layer vs Single Layer Woven EndoBridge Device in the Treatment of Intracranial Aneurysms: A Propensity Score-Matched Analysis.

BACKGROUND: The Woven EndoBridge (WEB) devices have been used for treating wide neck bifurcation aneurysms (WNBAs) with several generational enhancements to improve clinical outcomes. The original device dual-layer (WEB DL) was replaced by a single-layer (WEB SL) device in 2013. This study aimed to compare the effectiveness and safety of these devices in managing intracranial aneurysms. METHODS: A multicenter cohort study was conducted, and data from 1,289 patients with intracranial aneurysms treated with either the WEB SL or WEB DL devices were retrospectively analyzed. Propensity score matching was utilized to balance the baseline characteristics between the two groups. Outcomes assessed included immediate occlusion rate, complete occlusion at last follow-up, retreatment rate, device compaction, and aneurysmal rupture. RESULTS: Before propensity score matching, patients treated with the WEB SL had a significantly higher rate of complete occlusion at the last follow-up and a lower rate of retreatment. After matching, there was no significant difference in immediate occlusion rate, retreatment rate, or device compaction between the WEB SL and DL groups. However, the SL group maintained a higher rate of complete occlusion at the final follow-up. Regression analysis showed that SL was associated with higher rates of complete occlusion (OR: 0.19; CI: 0.04 to 0.8, p = 0.029) and lower rates of retreatment (OR: 0.12; CI: 0 to 4.12, p = 0.23). CONCLUSION: The WEB SL and DL devices demonstrated similar performances in immediate occlusion rates and retreatment requirements for intracranial aneurysms. The SL device showed a higher rate of complete occlusion at the final follow-up.

Treatment of large intracranial aneurysms using the Woven EndoBridge (WEB): a propensity score-matched analysis.

The Woven EndoBridge (WEB) device is primarily used for treating wide-neck intracranial bifurcation aneurysms under 10 mm. Limited data exists on its efficacy for large aneurysms. We aim to assess angiographic and clinical outcomes of the WEB device in treating large versus small aneurysms. We conducted a retrospective review of the WorldWide WEB Consortium database, from 2011 to 2022, across 30 academic institutions globally. Propensity score matching (PSM) was employed to compare small and large aneurysms on baseline characteristics. A total of 898 patients were included. There was no significant difference observed in clinical presentations, smoking status, pretreatment mRS, presence of multiple aneurysms, bifurcation location, or prior treatment between the two groups. After PSM, 302 matched pairs showed significantly lower last follow-up adequate occlusion rates (81% vs 90%, p = 0.006) and higher retreatment rates (12% vs 3.6%, p < 0.001) in the large aneurysm group. These findings may inform treatment decisions and patient counseling. Future studies are needed to further explore this area.

Off-Label Use of Woven EndoBridge Device for Intracranial Brain Aneurysm Treatment: Modeling of Occlusion Outcome.

INTRODUCTION: The Woven EndoBridge (WEB) device is emerging as a novel therapy for intracranial aneurysms, but its use for off-label indications requires further study. Using machine learning, we aimed to develop predictive models for complete occlusion after off-label WEB treatment and to identify factors associated with occlusion outcomes. METHODS: This multicenter, retrospective study included 162 patients who underwent off-label WEB treatment for intracranial aneurysms. Baseline, morphological, and procedural variables were utilized to develop machine-learning models predicting complete occlusion. Model interpretation was performed to determine significant predictors. Ordinal regression was also performed with occlusion status as an ordinal outcome from better (Raymond Roy Occlusion Classification [RROC] grade 1) to worse (RROC grade 3) status. Odds ratios (OR) with 95% confidence intervals (CI) were reported. RESULTS: The best performing model achieved an AUROC of 0.8 for predicting complete occlusion. Larger neck diameter and daughter sac were significant independent predictors of incomplete occlusion. On multivariable ordinal regression, higher RROC grades (OR 1.86, 95% CI 1.25-2.82), larger neck diameter (OR 1.69, 95% CI 1.09-2.65), and presence of daughter sacs (OR 2.26, 95% CI 0.99-5.15) were associated with worse aneurysm occlusion after WEB treatment, independent of other factors. CONCLUSION: This study found that larger neck diameter and daughter sacs were associated with worse occlusion after WEB therapy for aneurysms. The machine learning approach identified anatomical factors related to occlusion outcomes that may help guide patient selection and monitoring with this technology. Further validation is needed.

Transverse sinus pathologies, vestibular migraine and intracranial hypertension without papilledema.

BACKGROUND: In the absence of papilledema, the presentation of migraine and idiopathic intracranial hypertension (IIH) is very similar. In this respect, an IIH could be presented as a vestibular migraine. Our main objective in this case report is to demonstrate the similarities between IIH and vestibular migraine. CASES: This is a report of 14 patients who have IIH without papilledema presented as vestibular migraine to the clinic and followed from 2020 to 2022. RESULTS: The common presentation of patients was ear-facial pain, dizziness, and frequent pulsatile tinnitus. One-fourth of the patients reported episodes of true episodic vertigo. The average age was 37.8, the average BMI was 37.4, and the average lumbar puncture-opening pressure was 25.6 cm H2O. Transverse sinus venous flow alterations caused neuroimaging findings of sigmoid sinus dehiscence, empty sella, or tonsillar ectopia. Most patients improved with carbonic anhydrase inhibitors, and one patient was treated with a dural sinus stent. CONCLUSION: A transverse sinus stenosis, even in the non-dominant site, may elevate the CSF pressure in obese individuals. This stenosis causes dural sinus-related pulsatile tinnitus with characteristics different from those of an arterial origin. Dizziness is a common complaint in patients with IIH, just like VM. In our opinion, episodic vertigo in these patients is the direct effect of CSF flow alterations into the inner ear's vestibule. Patients with mild elevations will be presented to the clinic, similar to migraines with or without the presence of pulsatile tinnitus. Treatment requires lowering intracranial pressure and managing migraine symptoms.

Demonstration of chewing-related areas in the brain via functional magnetic resonance imaging.

Purpose: To localize and identify chewing-related areas and their connections with other centres in the human brain using functional magnetic resonance imaging (fMRI). Material and methods: The paradigm of the present study was block designed. Spontaneous and controlled chewing with sugar-free gum was used as the main task in a 3-Tesla fMRI unit with a 32-channel birdcage coil. Our study popu-lation comprised 32 healthy volunteers. To determine possible intersections, we also put the rosary pulling (silent tell one's beads) movement in the fMRI protocol. The data analyses were performed with the Statistical Parametric Mapping (SPM) toolbox integrated into the Matlab platform. Results: The superomedial part of the right cerebellum was activated during either pulling rosary beads or spontaneous chewing. This region, however, was not activated during controlled chewing. We did not find statistically significant activation or connection related to the brain stem. Conclusion: We have confirmed that the cerebellum plays an important role in chewing. However, we could not find a definite central pattern generator (CPG) in the brain stem, which has been hypothesized to underlie spontaneous chewing.

The role of computerized tomography angiography in the management of cases undergoing penile revascularization due to erectile dysfunction: prospective cohort study.

BACKGROUND: In this study, the role and efficiency of computerized tomography angiography (CTA) in the postoperative management of patients with penile revascularization were evaluated. METHODS: Between 2014 and 2018, penile revascularization surgery was performed in 78 patients who presented with the complaint of erectile dysfunction (ED). The mean age of the patients was 47.17 ± 13.26 (23-69) years. Patients with a regular sexual partner and relationship, who hadn't benefitted from medical treatment and who had ED complaints for at least three months were included in the study. The cases were divided into three groups according to their age (20-40, 41-60, and > 61 years). All the cases were evaluated preoperatively using the five and 15-item International Index of Erectile Dsysfunction (IIEF-5 and IIEF-15) questionnaire, cavernosometry, corpus cavernosum electromyography, and penil color doppler ultrasonography. At the postoperative third month, IIEF 5-15 questionnaire was repeated and anastomotic patency was evaluated by performing CTA scanning. RESULTS: CTA performed at the postoperative third month revealed anastomosis patency in 56. In 22 cases, the anastomosis area could not be observed. Among the patients with anastomosis patency, the rate of the IIEF-5 increase in the postoperative period was between 35.0 and 80.8%, while in those patients without anostomotic patency, the increase rate of IIEF-5 were between 12.5 and 23.3%. Increases in the IIEF-5 and IIEF-15 questionnaire scores were found to be significantly higher in the group in which anastomotic patency was observed on CTA compared to remaining patients. CONCLUSION: The CTA results and changes in the IIEF rates after penile revascularization had a high correlation. Anastomotic patency with CTA can guide the timing of more invasive procedures such as penile prosthesis implantation.

Exploiting lamina terminalis appearance and motion in prediction of hydrocephalus using convolutional LSTM network.

BACKGROUND: Evaluation of the lamina terminalis (LT) is crucial for non-invasive evaluation of the CSF diversion for the treatment of hydrocephalus. Together with deep learning algorithms, morphological and physiological analyses of the LT may play an important role in the management of hydrocephalus. AIM: We aim to show that exploiting the motion of LT can contribute to the evaluation of hydrocephalus using deep learning algorithms. METHODS: The dataset contains 61 True-fisp data with routine sequences 37 of which are labeled as 'hydrocephalus' and the others as 'normal condition'. A fifteen-year experienced neuroradiologist divided data into two groups. The first group, 'hydrocephalus', consists of patients with typical MRI findings (ventriculomegaly, enlargement of the third ventricular recesses and lateral ventricular horns, decreased mamillo-pontine distance, reduced frontal horn angle, thinning/elevation of the corpus callosum, and non-dilated convexity sulci), and the second group contains samples that did not show any symptoms or neurologic abnormality and labeled as 'normal condition'. The region of interest was determined by the radiologist supervisor to cover the LT. To achieve our purpose, we used both spatial and spatio-temporal analysis with two different deep learning architectures. We utilized Convolutional Neural Networks (CNN) for spatial and Convolutional Long Short-Term Memory (ConvLSTM) models for spatio-temporal analysis using an ROI around LT on sagittal True-fisp images. RESULTS: Our results show that 80.7% classification accuracy was achieved with the ConvLSTM model exploiting LT motion, whereas 76.5% and 71.6% accuracies were obtained by the 2D CNN model using all frames, and only the first frame from only spatial information, respectively. CONCLUSION: We suggest that the motion of the LT can be used as an additional attribute to the spatial information to evaluate the hydrocephalus.

Feasibility of 3D T1W sequences in contrast-material enhanced MR cisternography at 3T.

BACKGROUND: We investigated the diagnostic values and artifact severities of 3D-T1W sequences in the diagnosis of cerebrospinal fluid (CSF) leakage. METHODS: We retrospectively reviewed 3-tesla contrast-material enhanced MR cisternography exams of 22 patients with suspected CSF leakage in 4 years. The presence of the artifacts on 3D-T1W data was evaluated using a 4-point scale (0: none; 1: minimal; 2: moderate; 3: prominent). Agreements between CSF leakage results of the 3D-T1W sequences and consensus decisions were evaluated via kappa values. Artifact scores were analyzed by Fisher's exact test. RESULTS: The most compatible techniques with the consensus diagnoses were fat-saturated 3D-T1W-SPACE and 3D-T1W-VIBE sequences. The most artifact containing the 3D-T1W sequence was 3D-MPRAGE. DISCUSSION: 3D-SPACE and 3D-VIBE are more successful in evaluating CSF leakages compared to 3D-MPRAGE. 3D-SPACE has lower artifact scores compared to 3D-VIBE and 3D-MPRAGE sequences.

Cerebrovascular modelling for the management of aneurysm embolization using an intrasaccular flow diverter made by 3D printing.

Purpose: Using 3-dimensional (3D) printers, the creation of patient-specific models is possible before and after a therapeutic intervention. There are many articles about replicas for training and simulation of aneurysm clipping. However, no paper has focused on 3D replicas obtained from 3-tesla 3D time of flight (3D-TOF) MR angiography for intrasaccular flow diverter (WEB device) embolization of the cerebral aneurysms. In this paper, we aimed to investigate the feasibility of 3D printing models obtained from 3-tesla 3D-TOF data in the management and training of WEB-assisted embolization procedures. Case presentation: We presented a longitudinal case report with several 3D-TOF MRA prints over time. Three-tesla 3D-TOF data were converted into STL and G-code files using an open-source (3D-Slicer) program. We built patient-specific realistic 3D models of a patient with a middle cerebral artery trifurcation aneurysm, which were able to demonstrate the entire WEB device treatment procedure in the pre-intervention and post-intervention periods. The aneurysmatic segment was well displayed on the STL files and the 3D replicas. They allowed visualization of the aneurysmatic segment and changes within a 6-year follow-up period. We successfully showed the possibility of fast, cheap, and easy production of replicas for demonstration of the aneurysm, the parent vessels, and post-intervention changes in a simple way using an affordable 3D printer. Conclusions: 3D printing is useful for training the endovascular team and the patients, understanding the aneurysm/parent vessels, and choosing the optimal embolization technique/device. 3D printing will potentially lead to greater interventionalist confidence, decreased radiation dose, and improvements in patient safety.

The efficacy of the 3-dimensional vibe-caipirinha-dixon technique in the evaluation of pancreatic steatosis

Background/aim: CAIPIRINHA is a new technique in abdominal imaging. Pancreatic steatosis (PS) is a subject of increasing scientific interest. The aim of this study was to investigate the efficacy of the isotropic 3D-VIBE- CAIPIRINHA -DIXON technique on a new generation 3-tesla MR unit in the evaluation of PS. Materials and methods: In this retrospective study, the imaging findings of 49 patients with PS and 41 control subjects were examined. The pancreas-to-spleen ratio (PSR), pancreas-to-muscle ratio (PMR), and pancreatic signal intensity index (PSII) were defined as 3 new parameters and these indexes were calculated from the in-phase/out of phase 3D-VIBE- CAIPIRINHA-DIXON images. Results: The PSR, PMR, and PSII values were significantly different between the patient and control groups (P = 0.001, P = 0.009, P < 0.001, respectively). Statistically significant differences were observed between patient and control groups for ROI measurements of fatty areas on these sequences/images: subtraction (in-out) (P < 0.001), T2W HASTE (P < 0.001), DIXON-fat (P < 0.001), fat-suppressed T1W (P = 0.002), and subtraction (out-in) (P = 0.010). Conclusion: Evaluation of PS with the 3D-VIBE-CAIPIRINHA-DIXON technique can be made rapidly and effectively.

Assessment of the visual pathways in patients with neurofibromatosis-1 by 3S-space technique with 3-Tesla MRI

Background/aim/AIM: We aimed to evaluate the size/tortuosity of the optic nerve (ON) and the dilatation of the ON sheath (ONS) in neurofibromatosis type 1 (NF-1) patients with 3T-MRI, and to assess the usefulness of 3D-SPACE in imaging the optic pathway, ON, and ONS in NF-1 patients. Materials and methods: Twenty consecutive NF-1 patients without optic pathway glioma (OPG) (Group 1), 16 consecutive NF-1 patients with OPG (Group 2), and 19 controls were included in this study. The thickness and tortuosity of the ON and the diameter of the ONS were measured on STIR and 3D-SPACE images. Results: The thickness of the ON was similar in all groups on STIR images (P>0.05). The mean ONS diameter was higher in Group 2 with this sequence (P=0.009). Controls had significantly lower grades of ON tortuosity than Groups 1 and 2 (P=0.001), and Group 1 had significantly lower ON tortuosity compared to Group 2 (P=0.001). Severe tortuosity was only detected in Group 2. Conclusion: ON tortuosity and ONS diameter were increased in NF-1 patients in the presence of OPG. High-resolution cranium imaging with the 3D-SPACE technique using 3T-MRI seems to be helpful for detection of the optic pathway morphology and pathologies in NF-1 patients.

The efficacy of new oral contrast mixture for computed tomography enterography.

PURPOSE: To show the reliabilities of the new mixture (composed of water, methylcellulose, lactulose, locust bean gum, and sorbitol) and to compare the luminal distension and radiological confidence scores of this solution with water-lactulose mixture. MATERIAL AND METHODS: Computed tomography enterography (CTE) images in a three-year period were included randomly in our institutional review board-approved and retrospective study. Ninety-one patients drank a lactulose and water mixture (Group 1), and 54 patients drank the new mixture (Group 2). Patients who drank the oral contrast agent were taken to a 64-detector row multiple detector computed tomography machine. Coronal and sagittal reformatted images were also formed. The gastrointestinal tract was divided into 11 segments for scoring. Each segment was graded for distensional and radiological confidence. CTE images were evaluated by two radiologists. RESULTS: Inter- and intra-reader reliabilities were good or excellent for all gastrointestinal segments in both groups (p < 0.001). The best κ values were obtained in sigmoid colon assessments. Lower agreement values were detected in duodenum and jejunum scores. The new mixture group (Group 2) showed better results than Group 1 for ileum and colonic segments according to distension and confidence scorings. CONCLUSIONS: Inter- and intra-reader reliabilities of the new mixture were good or excellent for CTE. The new mixture seems to be more efficient and reliable for ileum and colon. The new mixture can increase bowel distention, radiological confidence, and quality in CTE evaluations.

Efficiency and reporting confidence analysis of sequential dual-energy subtraction for thoracic x-ray examinations.

Rationale and objectives: We aimed to report and compare accuracy, reproducibility, and reporting confidence between thoracic dual-energy subtraction (DES) and routine posterior-anterior chest radiography (PA-CR) techniques. Materials (patients) and methods: We obtained DES (D1-D4) images from 96 patients using DES and a high-resolution dynamic flat-panel detector in combination. We compared the DES images of these patients with their PA-CR images. The maximum time interval between performing DES and PA-CR was nine weeks. Two radiologists evaluated abnormal findings on DES and PA-CR images using a three-point scale, and reporting confidence was scored using a four-point scale. The intra- and interobserver agreement values of the scores were analyzed. Further, the radiation exposure doses during PA-CR and DES acquisitions were calculated. Results: The intra- and interobserver agreement values of PA-CR and DES images were good. The reporting confidence scores for DES were generally higher than those for PA-CR. Between bone-subtracted (D3) and soft-tissue-subtracted (D4) images, the former was more successful and useful in the evaluation of bone structures, whereas the latter was better in the evaluation of consolidation and/or solitary nodules. Conclusions: DES has the potential to improve the accuracy, reproducibility, and reporting confidence of thoracic radiography. It also has the potential to provide a better diagnosis of chest pathologies using relatively low dose radiation.

An inductively coupled ultra-thin, flexible, and passive RF resonator for MRI marking and guiding purposes: Clinical feasibility.

PURPOSE: The purpose of this study is to develop a wireless, flexible, ultra-thin, and passive radiofrequency-based MRI resonant fiducial marker, and to validate its feasibility in a phantom model and several body regions. METHODS: Standard microfabrication processing was used to fabricate the resonant marker. The proposed marker consists of two metal traces in the shape of a square with an edge length of 8 mm, with upper and lower traces connected to each other by a metalized via. A 3T MRI fiducial marking procedure was tested in phantom and ex vivo, and then the marker's performance was evaluated in an MRI experiment using humans. The radiofrequency safety was also tested using temperature sensors in the proximity of the resonator. RESULTS: A flexible resonator with a thickness of 115 µm and a dimension of 8 × 8 mm was obtained. The experimental results in the phantom show that at low background flip angles (6-18°), the resonant marker enables precise and rapid visibility, with high marker-to-background contrast and signal-to-noise ratio improvement of greater than 10 in the vicinity of the marker. Temperature analysis showed a specific absorption ratio gain of 1.3. Clinical studies further showed a successful biopsy procedure using the fiducial marking functionality of our device. CONCLUSIONS: The ultra-thin and flexible structure of this wireless flexible radiofrequency resonant marker offers effective and safe MR visualization with high feasibility for anatomic marking and guiding at various regions of the body. Magn Reson Med 80:361-370, 2018. © 2017 International Society for Magnetic Resonance in Medicine.

A temperature sensor implant for active implantable medical devices for in vivo subacute heating tests under MRI.

PURPOSE: To introduce a temperature sensor implant (TSI) that mimics an active implantable medical device (AIMD) for animal testing of MRI heating. Computer simulations and phantom experiments poorly represent potential temperature increases. Animal experiments could be a better model, but heating experiments conducted immediately after the surgery suffer from alterations of the thermoregulatory and tissue properties during acute testing conditions. Therefore, the aim of this study was to introduce a temperature sensor implant that mimics an AIMD and capable of measuring the electrode temperature after implantation of the device without any further intervention at any time after the surgery in an animal model. METHODS: A battery-operated TSI, which resembled an AIMD, was used to measure the lead temperature and impedance and the case temperature. The measured values were transmitted to an external computer via a low-power Bluetooth communication protocol. In addition to validation experiments on the phantom, a sheep experiment was conducted to test the feasibility of the system in subacute conditions. RESULTS: The measurements had a maximum of 0.5°C difference compared to fiber-optic temperature probes. In vivo animal experiments demonstrated feasibility of the system. CONCLUSION: An active implant, which can measure its own temperature, was proposed to investigate implant heating during MRI examinations. Magn Reson Med 79:2824-2832, 2018. © 2017 International Society for Magnetic Resonance in Medicine.

Evaluation of the Communication Between Arachnoid Cysts and Neighboring Cerebrospinal Fluid Spaces by T2W 3D-SPACE With Variant Flip-Angle Technique at 3 T.

PURPOSE: Phase-contrast cine magnetic resonance imaging (PC-MRI) is a widely used technique for determination of possible communication of arachnoid cysts (ACs). Three-dimensional (3D) sampling perfection with application-optimized contrasts using different flip-angle evolutions (3D-SPACE) technique is a relatively new method for 3D isotropic scanning of the entire cranium within a short time. In this research, the usage of the 3D-SPACE technique in differentiation of communicating or noncommunicating type ACs was evaluated. MATERIALS AND METHODS: Thirty-five ACs in 34 patients were retrospectively examined. The 3D-SPACE, PC-MRI, and contrast material-enhanced cisternography (if present) images of the patients were analyzed. Each cyst was described according to cyst size/location, third ventricle diameter, Evans index, and presence of hydrocephalus. Communication was defined as absent (score 0), suspected (score 1), or present (score 2) on each sequence. Results of PC-MRI or cisternography (if available) examinations were used as criterion standard techniques to categorize all cysts as communicating or noncommunicating type. The results of 3D-SPACE were compared with criterion standard techniques. The comparisons between groups were performed using Mann-Whitney and Fisher exact tests. RESULTS: For demonstration of communication status of the cysts, criterion standard test results and 3D-SPACE findings were almost in perfect harmony (κ[95% confidence interval: 0.94]; P < 0.001). When evaluating the communicative properties, 3D-SPACE findings correlated with other final results at a rate of 97%. There is a positive correlation with third ventricular diameters and Evans index for all patients (r = 0.77, P < 0.001). For other analyzed variables, there is no significant difference or correlation between the groups. CONCLUSIONS: The 3D-SPACE technique is an easy, useful, and noninvasive alternative for the evaluation of morphology, topographical relationships, and communication status of ACs.

Assessment of Liliequist membrane by 3D-SPACE technique at 3 T.

INTRODUCTION: Liliequist membrane (LM) is the most important anatomic structure for the success of endoscopic third ventriculostomy (ETV). Identification of this membrane is difficult with conventional MRI techniques. The purpose of this retrospective study is to determine the impact of three-dimensional sampling perfection with application-optimized contrasts using different flip-angle evolutions (3D-SPACE) sequence with variant flip-angle mode (VFAM) in the assessment of LM at 3-T MRI devices. METHODS: 3D-SPACE with VFAM images were obtained in 445 patients. LM visibility and integrity were scored as 0 (good), 1 (moderate), and 2 (poor) on these images for each parts (sellar, diencephalic, and mesencephalic) and overall of the membrane. RESULTS: According to the LM overall integrity scores, 11 % (48 cases) of the patients had perforated membrane. According to subsegmental integrity scores, sellar part was completely intact in 63 % of patients, diencephalic segment was completely intact in 60 % of the patients, and mesencephalic segment was completely intact in 95 % of the patients. Visibility scores of the third ventricle inferior wall were significantly higher in the patients with intact LM (p = 0.001). There was not any statistically significant relationship between LM pattern and overall integrity (p = 0.352). LM attachment sites could be detected easier in the patients who had better visibility of third ventricle inferior wall or intact LM (p < 0.001 for both). CONCLUSION: 3D-SPACE technique is a useful alternative for the evaluation of morphology, integrity, individual variations, topographic relationships, and visibility of LM since it has some advantages including lower SAR values, fewer artifacts, and high-resolution images.

Feasibility of 3-dimensional sampling perfection with application optimized contrast sequence in the evaluation of patients with hydrocephalus.

PURPOSE: This study aimed to investigate the effectiveness and additive value of T2W 3-dimensional sampling perfection with application optimized contrast (3D-SPACE) with variant flip-angle mode in imaging of all types of hydrocephalus. Our secondary objective was to assess the reliability of 3D-SPACE sequence and correspondence of the results with phase-contrast magnetic resonance imaging (PC-MRI)-based data. MATERIALS AND METHODS: Forty-one patients with hydrocephalus have undergone 3-T MRI. T2W 3D-SPACE sequence has been obtained in addition to routine hydrocephalus protocol. Cerebrospinal fluid circulation, presence/type/etiology of hydrocephalus, obstruction level scores, and diagnostic levels of confidence were evaluated separately by 2 radiologists. In the first session, routine sequences with PC-MRI were evaluated, and in another session, only 3D-SPACE and 3-dimensional magnetization prepared rapid acquisition gradient echo sequences were evaluated. Results obtained in these sessions were compared with each other and those obtained in consensus session. RESULTS: Agreement values were very good for both 3D-SPACE and PC-MRI sequences (P < 0.001 for all). Also, the correlation of more experienced reader's 3D-SPACE-based scores and consensus-based scores was perfect (κ = 1, P < 0.001).The mean value of PC-MRI-based confidence scores were lower than those obtained in 3D-SPACE and consensus sessions. CONCLUSIONS: T2W 3D-SPACE sequence provides morphologic cerebrospinal fluid flow data. It is a noninvasive technique providing extensive multiplanar reformatted images with a lower specific absorption rate. These advantages over PC-MRI make 3D-SPACE sequence a promising tool in management of patients with hydrocephalus.

Decoding pulsatile patterns of cerebrospinal fluid dynamics through enhancing interpretability in machine learning.

Analyses of complex behaviors of Cerebrospinal Fluid (CSF) have become increasingly important in diseases diagnosis. The changes of the phase-contrast magnetic resonance imaging (PC-MRI) signal formed by the velocity of flowing CSF are represented as a set of velocity-encoded images or maps, which can be thought of as signal data in the context of medical imaging, enabling the evaluation of pulsatile patterns throughout a cardiac cycle. However, automatic segmentation of the CSF region in a PC-MRI image is challenging, and implementing an explained ML method using pulsatile data as a feature remains unexplored. This paper presents lightweight machine learning (ML) algorithms to perform CSF lumen segmentation in spinal, utilizing sets of velocity-encoded images or maps as a feature. The Dataset contains 57 PC-MRI slabs by 3T MRI scanner from control and idiopathic scoliosis participants are involved to collect data. The ML models are trained with 2176 time series images. Different cardiac periods image (frame) numbers of PC-MRIs are interpolated in the preprocessing step to align to features of equal size. The fivefold cross-validation procedure is used to estimate the success of the ML models. Additionally, the study focusses on enhancing the interpretability of the highest-accuracy eXtreme gradient boosting (XGB) model by applying the shapley additive explanations (SHAP) technique. The XGB algorithm presented its highest accuracy, with an average fivefold accuracy of 0.99% precision, 0.95% recall, and 0.97% F1 score. We evaluated the significance of each pulsatile feature's contribution to predictions, offering a more profound understanding of the model's behavior in distinguishing CSF lumen pixels with SHAP. Introducing a novel approach in the field, develop ML models offer comprehension into feature extraction and selection from PC-MRI pulsatile data. Moreover, the explained ML model offers novel and valuable insights to domain experts, contributing to an enhanced scholarly understanding of CSF dynamics.

The Relationship Between Intramural Fat Accumulation and Sarcopenia on MR Enterography Exams in Patients with Crohn's Disease.

Research on magnetic resonance enterography (MRE) and sarcopenia for assessing Crohn's disease (CD) is growing. Our study examined the connections between the presence of sarcopenia, intramural fat accumulation (IFA), and clinical, laboratory, and MRE findings.This retrospective study was conducted on 112 patients with suspected or diagnosed CD who underwent 3-tesla MRE. The study examined the correlation between sarcopenia-related parameters and MRE findings. Results of MRE exams and clinical and laboratory results were statistically analyzed. The Kruskal-Wallis, Pearson chi-square, and Fisher-Freeman-Halton tests were used for comparison.It was determined that patients with active inflammation on a chronic basis had more IFA than the others (p<0.001). There were positive relationships between IFA and intramural edema (p<0.001). There were positive correlations between IFA and high b-values and negative correlations with apparent diffusion coefficient values (p<0.05). Positively significant relationships were found between IFA and wall thickness, affected segment length, disease duration, and sedimentation values (p<0.05). Strong correlations were found between sarcopenia and the CD activity index as well as wall thickness (p<0.001/p=0.003). There was no significant relationship between steroid usage and other variables.The presence of IFA is associated with chronic inflammation. There was no clear relationship between steroid use and IFA. Our findings support the idea that sarcopenia is related to the activity of CD. Further comprehensive research is required on these subjects. · The usage of MR enterography for the management of CD is increasing day by day due to its advantages.. · There is a paucity of evidence regarding the relationship between sarcopenia and MR enterography findings in patients with CD.. · Intramural fat accumulation (IFA) is a sign of chronicity in patients with CD.. · The presence of IFA seems to be associated with active inflammation on a chronic basis.. · There was no clear relationship between steroid use and IFA.. · Algin O, Günes YC, Cankurtaran RE et al. The Relationship Between Intramural Fat Accumulation and Sarcopenia on MR Enterography Exams in Patients with Crohn's Disease. Fortschr Röntgenstr 2024; DOI 10.1055/a-2330-8148.