Evaluation of an antithrombotic surface coated flow diverter in rabbit model.

OBJECTIVE: Flow diverters (FDs) carry the risk of thromboembolic complications associated with the device and bleeding complications associated with dual antiplatelet therapy. We hypothesize that an antithrombotic surface coated flow diverter(BSCFD) would have less acute thrombus formation and better endothelialization on the device surface compared to uncoated flow diverter. METHODS: An antithrombotic surface coated FD(BSCFD) was developed. Acute clot formation and chronic endothelialization over the device were assessed in 8 rabbit models comparing to its prototype FD(PFD) at 2 hours and 1 month by Scanning Electron Microscopy(SEM) and Histologic images. Nonparametric score data, including thrombus, injury, endothelialization, adventitial inflammation, intramural bleeding and intimal hyperplasia were compared between BSCFD and PFD using Kendall coefficient of rank correlation. RESULTS: Parent artery and branch artery were patent on DSA in 8 BSCFDs and 6 PFDs. There was 1 intra-stent thrombosis in PFDs at 2 hours and 1 intra-stent stenosis in PFD at 1 month. SEM at 2 hours showed that large amount of blood cells adhered to the surface of all 4 PFDs, and no blood cells were found on the surface of all 4 BSCFDs. At SEM and histological analysis of 1 month, there were less inflammation(Kendall's Tau-B=-0.818, p＝0.022), less vessel wall injury（Kendall's Tau-B=-0.764, p＝0.032）and better endothelialization(Kendall's Tau-B=0.818, p＝0.022) in BSCFDs. CONCLUSION: In the rabbit model, the BSCFD is associated with less thrombus formation at acute stage, less inflammation, less vessel injury and better endothelialization on the device surface compared to the PFD.

Rupture risk assessment in cerebral arteriovenous malformations: an ensemble model using hemodynamic and morphological features.

BACKGROUND: Cerebral arteriovenous malformation (AVM) is a cerebrovascular disorder posing a risk for intracranial hemorrhage. However, there are few reliable quantitative indices to predict hemorrhage risk accurately. This study aimed to identify potential biomarkers for hemorrhage risk by quantitatively analyzing the hemodynamic and morphological features within the AVM nidus. METHODS: This study included three datasets comprising consecutive patients with untreated AVMs between January 2008 to December 2023. Training and test datasets were used to train and evaluate the model. An independent validation dataset of patients receiving conservative treatment was used to evaluate the model performance in predicting subsequent hemorrhage during follow-up. Hemodynamic and morphological features were quantitatively extracted based on digital subtraction angiography (DSA). Individual models using various machine learning algorithms and an ensemble model were constructed on the training dataset. Model performance was assessed using the confusion matrix-related metrics. RESULTS: This study included 844 patients with AVMs, distributed across the training (n=597), test (n=149), and validation (n=98) datasets. Five hemodynamic and 14 morphological features were quantitatively extracted for each patient. The ensemble model, constructed based on five individual machine-learning models, achieved an area under the curve of 0.880 (0.824-0.937) on the test dataset and 0.864 (0.769-0.959) on the independent validation dataset. CONCLUSION: Quantitative hemodynamic and morphological features extracted from DSA data serve as potential indicators for assessing the rupture risk of AVM. The ensemble model effectively integrated multidimensional features, demonstrating favorable performance in predicting subsequent rupture of AVM.

Predicting postinterventional rupture of intracranial aneurysms using arteriography-derived radiomic features after pipeline embolization.

Background and purpose: Postinterventional rupture of intracranial aneurysms (IAs) remains a severe complication after flow diverter treatment. However, potential hemodynamic mechanisms underlying independent predictors for postinterventional rupture of IAs remain unclear. In this study, we employed arteriography-derived radiomic features to predict this complication. Methods: We included 64 patients who underwent pipeline flow diversion for intracranial aneurysms, distinguishing between 16 patients who experienced postinterventional rupture and 48 who did not. We performed propensity score matching based on clinical and morphological factors to match these patients with 48 patients with postinterventional unruptured IAs at a 1:3 ratio. Postinterventional digital subtraction angiography were used to create five arteriography-derived perfusion parameter maps and then radiomics features were obtained from each map. Informative features were selected through the least absolute shrinkage and selection operator method with five-fold cross-validation. Subsequently, radiomics scores were formulated to predict the occurrence of postinterventional IA ruptures. Prediction performance was evaluated with the training and test datasets using area under the curve (AUC) and confusion matrix-derived metrics. Results: Overall, 1,459 radiomics features were obtained, and six were selected. The resulting radiomics scores had high efficacy in distinguishing the postinterventional rupture group. The AUC and Youden index were 0.912 (95% confidence interval: 0.767-1.000) and 0.847 for the training dataset, respectively, and 0.938 (95% confidence interval, 0.806-1.000) and 0.800 for the testing dataset, respectively. Conclusion: Radiomics scores generated using arteriography-derived radiomic features effectively predicted postinterventional IA ruptures and may aid in differentiating IAs at high risk of postinterventional rupture.

Rupture-Related Features of Cerebral Arteriovenous Malformations and Their Utility in Predicting Hemorrhage.

BACKGROUND: Evaluating rupture risk in cerebral arteriovenous malformations currently lacks quantitative hemodynamic and angioarchitectural features necessary for predicting subsequent hemorrhage. We aimed to derive rupture-related hemodynamic and angioarchitectural features of arteriovenous malformations and construct an ensemble model for predicting subsequent hemorrhage. METHODS: This retrospective study included 3 data sets, as follows: training and test data sets comprising consecutive patients with untreated cerebral arteriovenous malformations who were admitted from January 2015 to June 2022 and a validation data set comprising patients with unruptured arteriovenous malformations who received conservative treatment between January 2009 and December 2014. We extracted rupture-related features and developed logistic regression (clinical features), decision tree (hemodynamic features), and support vector machine (angioarchitectural features) models. These 3 models were combined into an ensemble model using a weighted soft-voting strategy. The performance of the models in discriminating ruptured arteriovenous malformations and predicting subsequent hemorrhage was evaluated with confusion matrix-related metrics in the test and validation data sets. RESULTS: A total of 896 patients (mean±SD age, 28±14 years; 404 women) were evaluated, with 632, 158, and 106 patients in the training, test, and validation data sets, respectively. From the training set, 9 clinical, 10 hemodynamic, and 2912 pixel-based angioarchitectural features were extracted. A logistic regression model was built using 4 selected clinical features (age, nidus size, location, and venous aneurysm), whereas a decision-tree model was constructed from 4 hemodynamic features (outflow time, stasis index, cerebral blood flow, and outflow volume ratio). A support vector machine model was designed using 5 pixel-based angioarchitectural features. In the validation data set, the accuracy, sensitivity, specificity, and area under the curve of the ensemble model for predicting subsequent hemorrhages were 0.840, 0.889, 0.823, and 0.911, respectively. CONCLUSIONS: The ensemble model incorporating clinical, hemodynamic, and angioarchitectural features showed favorable performance in predicting subsequent hemorrhage of cerebral arteriovenous malformations.

Prediction of Venous Trans-Stenotic Pressure Gradient Using Shape Features Derived From Magnetic Resonance Venography in Idiopathic Intracranial Hypertension Patients.

OBJECTIVE: Idiopathic intracranial hypertension (IIH) is a condition of unknown etiology associated with venous sinus stenosis. This study aimed to develop a magnetic resonance venography (MRV)-based radiomics model for predicting a high trans-stenotic pressure gradient (TPG) in IIH patients diagnosed with venous sinus stenosis. MATERIALS AND METHODS: This retrospective study included 105 IIH patients (median age [interquartile range], 35 years [27-42 years]; female:male, 82:23) who underwent MRV and catheter venography complemented by venous manometry. Contrast enhanced-MRV was conducted under 1.5 Tesla system, and the images were reconstructed using a standard algorithm. Shape features were derived from MRV images via the PyRadiomics package and selected by utilizing the least absolute shrinkage and selection operator (LASSO) method. A radiomics score for predicting high TPG (≥ 8 mmHg) in IIH patients was formulated using multivariable logistic regression; its discrimination performance was assessed using the area under the receiver operating characteristic curve (AUROC). A nomogram was constructed by incorporating the radiomics scores and clinical features. RESULTS: Data from 105 patients were randomly divided into two distinct datasets for model training (n = 73; 50 and 23 with and without high TPG, respectively) and testing (n = 32; 22 and 10 with and without high TPG, respectively). Three informative shape features were identified in the training datasets: least axis length, sphericity, and maximum three-dimensional diameter. The radiomics score for predicting high TPG in IIH patients demonstrated an AUROC of 0.906 (95% confidence interval, 0.836-0.976) in the training dataset and 0.877 (95% confidence interval, 0.755-0.999) in the test dataset. The nomogram showed good calibration. CONCLUSION: Our study presents the feasibility of a novel model for predicting high TPG in IIH patients using radiomics analysis of noninvasive MRV-based shape features. This information may aid clinicians in identifying patients who may benefit from stenting.

Classification of anterior communicating aneurysms on a basis of endovascular treatments.

BACKGROUND AND PURPOSE: The anterior communicating artery (Acoma) aneurysms are difficult to understand because of their anatomical variations. This study reported a new classification of Acoma aneurysms on a basis of endovascular treatments. METHODS: This retrospective study enrolled consecutive 94 patients harbored 100 Acoma aneurysms treated with coil embolization. All Acoma aneurysms were classified into 5 orientations (straight, superior, inferior, anterior, and posterior) based on the axis connecting A1 origin and the base of the aneurysm. Aneurysm characteristics, endovascular treatments, angiographic, and clinical outcomes were evaluated using this classification. RESULTS: According to this classification, there were 64 (64%) straight, 16 (16%) inferior, 16 (16%) superior, 2 (2%) anterior, and 2 (2%) posterior projection aneurysms. There were significant differences between different groups in aneurysm height (p=0.009) and aneurysm neck size (p = 0.003), and in endovascular treatments (p=0.006). There was a significant difference in the proportion of rupture presentation among the three groups of straight, inferior, and superior (p = 0.019). There was no difference in the results of postoperative angiography (p = 0.090). An excellent functional outcome with an mRS ≤1 was achieved in 91 (96.8%) patients. CONCLUSIONS: This classification of Acoma aneurysms based on the axis connecting A1 origin and the base of the aneurysm is associated with aneurysm height, aneurysm neck size, and in need for stent-assisted therapy. Endovascular embolization can provide the same effective treatment for aneurysms in all directions.

Retrograde placement of flow diversion for the treatment of giant internal carotid artery aneurysm.

The use of flow diverters has been well-validated for the treatment of giant internal carotid artery aneurysms. However, in certain complex cases, the navigation of stent microcatheters across the neck may pose a relative challenge.1-3 In this technical video (video 1), we present the case of a patient in their 50s experiencing discomfort in the left eye. Angiography identified a giant aneurysm in the ophthalmic segment of the left internal carotid artery. Before seeking care at our institution, the patient had two interventional procedures, both unsuccessful due to difficulties in navigating the microcatheter past the aneurysm neck.4-5 In our management, after multiple unsuccessful anterograde attempts, we employed a retrograde strategy via the vertebral-basilar-posterior communicating artery route. This approach facilitated the successful deployment of the flow diverter and led to effective aneurysm embolization, underscoring the value of retrograde techniques for challenging cases.

Quantitative evaluation of the subsequent hemorrhage with arteriography-derived hemodynamic features in patients with untreated cerebral arteriovenous malformation.

Background: Patients with untreated cerebral arteriovenous malformations (AVMs) are at risk of intracerebral hemorrhage. However, treatment to prevent AVM hemorrhage carries risks. Objective: This study aimed to analyze the AVM nidus-related hemodynamic features and identify the risk factors for subsequent hemorrhage. Methods: We retrospectively identified patients with untreated AVMs who were assessed at our institution between March 2010 and March 2021. Patients with ≥6 months of treatment-free and hemorrhage-free follow-up after diagnosed by digital subtraction angiography were included in subsequent examinations. The hemodynamic features were extracted from five contrast flow-related parameter maps. The Kaplan-Meier analyses and Cox proportional hazards regression models were used to find the potential risk factors for subsequent hemorrhage. Results: Overall, 104 patients with a mean follow-up duration of 3.37 years (median, 2.42 years; range, 6-117 months) were included in study, and the annual risk of rupture was 3.7%. Previous rupture (hazard ratio [HR], 4.89; 95% confidence interval [CI], 1.16-20.72), deep AVM location (HR, 4.02; 95% CI, 1.01-15.99), higher cerebral blood volume (HR, 3.35; 95% CI, 1.15-9.74) in the nidus, and higher stasis index (HR, 1.54; 95% CI, 1.06-2.24) in the nidus were associated with subsequent hemorrhage in untreated AVMs. Conclusion: Higher cerebral blood volume and stasis index in the nidus suggest increased blood inflow and stagnant blood drainage. The combination of these factors may cause subsequent hemorrhage of AVMs.

Case report: A case report of Alport syndrome caused by a novel mutation of COL4A5.

Alport syndrome (#308940) is an X-linked genetic disease with clinical manifestations, such as hematuria, proteinuria, renal insufficiency, and end-stage renal disease. The disease is characterized by the thinning of the glomerular basement membrane in the early stages and the thickening of the glomerular basement membrane in the late stages and may be associated with ocular lesions and varying degrees of sensorineural deafness. Herein, we report a case of Alport syndrome caused by a de novo mutation in COL4A5. The patient was a young male with clinical manifestations of hematuria and massive proteinuria who was diagnosed with Alport syndrome based on renal pathology and genetic testing.

Pipeline embolization devices for the treatment of nonsaccular aneurysms in pediatric patients.

Objective: Pediatric nonsaccular aneurysms are rare but challenging lesions; pipeline embolization devices (PEDs) are their potential treatment option. In this study, we aimed to evaluate the safety and efficacy of PEDs for treatment of these aneurysms. Methods: We retrospectively selected pediatric patients with nonsaccular aneurysms treated using PEDs between June 2015 and July 2021 from our prospectively maintained database. For each patient, demographics, aneurysm characteristics, procedure details, and clinical and angiographic follow-up data were collected and summarized. Results: This study included 16 pediatric patients with 16 nonsaccular aneurysms treated with PEDs. A median clinical follow-up time of 1,376 days was achieved in 93.75% of the patients. The complication rate of the included patients was 25%, with two patients developing mass effect, one patient undergoing major ischemic stroke, and one patient experiencing stent foreshortening after the procedure. The complete occlusion rate of aneurysms without any neurologic sequelae was 93.33%, with a median angiographic follow-up period of 246 days. The mortality rate was 6.25%. Conclusions: The use of PEDs to treat pediatric nonsaccular aneurysms is feasible, with a high rate of complete occlusion of the aneurysm and favorable follow-up outcomes.

Estimation of venous sinus pressure drop in patients with idiopathic intracranial hypertension using 4D-flow MRI.

OBJECTIVE: We aimed to explore a non-invasive estimate of pressure drop in patients who undergo venous sinus stenting to treat idiopathic intracranial hypertension (IIH). METHODS: This prospective study included 28 IIH patients scheduled for venous stenting. 4D-flow MRI was acquired 24-48 h before venous manometry. Manometry-obtained pressure drop (Mp) was dichotomized into low (Lp: 0-8 mmHg) and high (Hp: 8-30 mmHg) groups. Hemodynamic indices were compared between Lp and Hp. Trans-stenotic pressure drop was estimated by work-energy equation, simplified Bernoulli equation, vorticity magnitude, and velocity difference between inlet and outlet and was compared with Mp. Measurement agreement, correlation, and accuracy were evaluated using the κ coefficient, Pearson's r, and confusion matrix-derived accuracy. RESULTS: Among 28 patients (mean age 38.8 ± 12.7), 19 (67.9%) were female. Work-energy equation-estimated pressure drop (WEp) had strong correlation (r = 0.91, 95% confidence interval [CI]: 0.81-0.96, p < 0.001) and high agreement (intraclass correlation coefficient = 0.90, 95% CI: 0.78-0.95, p < 0.001) with Mp. WEp classified Lp and Hp with an accuracy of 0.96. The κ value between WEp and Mp was 0.92 (95% CI: 0.78-1.00). In the work-energy equation, the viscosity energy term (Ve) had the largest weights, and the ratio of Ve to the summation of the three energy terms was 0.93 ± 0.07. Ve had strong correlation with mVort (r = 0.93, 95% CI: 0.85-0.97, p < 0.001), and mean vorticity magnitude was significantly elevated in Hp compared to that in Lp (259.8 vs. 174.9 mL/s, p < 0.001). CONCLUSION: Trans-stenotic pressure drop in IIH can be estimated using the work-energy equation with favorable accuracy. KEY POINTS: • Trans-stenotic pressure drop in patients with idiopathic intracranial hypertension can be estimated accurately with the work-energy equation using the 4D-flow MRI full velocity field. • Compared with traditional venous sinus manometry, the 4D-flow MRI-derived pressure drop is totally non-invasive and cost-saving. • 4D-flow MRI may help neurointerventionalist to select IIH patients suitable for venous sinus stenting.

Quantitative evaluation of the hemodynamic differences between ruptured and unruptured cerebral arteriovenous malformations using angiographic parametric imaging-derived radiomics features.

PURPOSE: Imaging features of cerebral arteriovenous malformations (AVMs) are mainly interpreted according to demographic and qualitative anatomical characteristics. This study aimed to use angiographic parametric imaging (API)-derived radiomics features to explore whether these features extracted from digital subtraction angiography (DSA) were associated with the hemorrhagic presentation of AVMs. METHODS: Patients with AVM were retrospectively evaluated. Among them, 80% were randomly assigned to a training dataset, and the remaining 20% were assigned to an independent test dataset. Radiomics features were extracted from DSA by API. Then, informative features were selected from radiomics features and clinical features using the Least Absolute Shrinkage and Selection Operator (LASSO) algorithm. A model was constructed based on the selected features to classify the dichotomous hemorrhagic presentation in the training dataset. The model performance was evaluated in the test dataset with confusion matrix-related metrics. RESULTS: A total of 529 consecutive patients with AVMs between July 2011 and December 2020 were included in this study. After being selected by the LASSO algorithm and analyzed by multivariable logistic regression, three clinical features, namely, age (p = 0.01), nidus size (p < 0.001), and venous drainage patterns (p < 0.001), and four radiomics features were used to construct a model in the training dataset. On the independent test dataset, the model demonstrated a sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of 0.852, 0.844, 0.881, 0.809, and 0.849, respectively. CONCLUSION: The radiomics features extracted from DSA by API could be potential indicators for the hemorrhagic presentation of AVMs.

Clinical Characteristics and Multimodality Therapy Outcomes in 304 Pediatric Patients with Cerebral Arteriovenous Malformations.

BACKGROUND: Clinical follow-up data of pediatric patients with cerebral arteriovenous malformations (AVMs) are limited. This study investigated the characteristics of AVMs in children and analyzed the clinical outcomes of multimodality therapy in pediatric patients with AVMs at a single center. METHODS: This retrospective study included consecutive patients diagnosed with AVMs at our institution between August 2008 and June 2018. Data on demographic characteristics, AVM features, and clinical outcomes were collected. Patients aged <18 years at admission were defined as children. RESULTS: Overall, 1009 patients with AVMs were included, with 304 (30.1%) patients aged <18 years. AVMs in pediatric patients were more likely to present with intracranial hemorrhage, mostly located in deep areas of the brain. A small nidus, exclusively deep drainage, and deep AVM location were associated with hemorrhage in children; Kaplan-Meier analysis revealed that patients with ruptured AVMs had a higher risk of developing a follow-up hemorrhage than those with unruptured AVMs. Among 290 children who were followed up, the multivariate regression analysis showed that a higher pretreatment modified Rankin Scale score, deep AVM location, and conservative treatment were significantly associated with unfavorable outcomes. CONCLUSIONS: In pediatric patients, AVMs were more likely to present with intracranial hemorrhage than that in adults. Hemorrhagic presentation in children was associated with a small nidus, exclusively deep drainage, and deep AVM location. Pediatric patients with ruptured AVMs had significantly higher risks of follow-up hemorrhage than those with unruptured AVMs. Our clinical results suggest that nonconservative treatment is better for pediatric patients with AVMs.

Proof-of-Principle for AVM Embolization Complications Caused by the Proximal Occlusion Technique Using Onyx: A Theoretical Basis for Ante-Grade Drifting Technique.

To analyze the complications of the standard proximal plug technique in arteriovenous malformations (AVMs) embolization by Onyx and promote ante-grade drifting technique for AVM embolization. Seven publications reporting complications of AVM embolization by Onyx were identified and reviewed. Render descriptive statistics regarding causes of ischemic and hemorrhagic complications within 1 month following treatment were provided. A novel Onyx injection technique was proposed to overcome these problems. All reported transarterial Onyx AVM embolizations were conducted by employing the proximal plug technique. Causes of complications elicited by utilizing this strategy may generally be attributed to long-fluoroscopy and long-procedure times, embolisate reflux across a considerable extent of the vessel, catheter entrapment, extravasation of Onyx from the arterial lumen, catheter transgression through the arterial wall, the use of an Onyx volume exceeding, and venous occlusion preceding arterial feeder shutdown. Complications occurring during the course of attempts at embolizing AVMs utilizing Onyx constitute unfortunate causes of patient morbidity resulting from this conventional technique. We suggest that institution of a novel "ante-grade drifting technique" for Onyx injection may avoid these commonly elicited deficits. The proximal plug technique has a series of drawbacks that lead to serious adverse outcomes of AVM embolization. The Onyx embolization technology for AVM could be updated to improve clinical outcomes.

Comparison of Pipeline Embolization Device and Traditional Endovascular Therapeutic Approaches in Distal Cerebral Circulation Aneurysms Using Propensity Score Matching Analysis.

Background: Coiling and stent-assisted coiling remain the first-line treatments for distal cerebral circulation aneurysms (DCCAs). The off-label use of the pipeline embolization device (PED) for these aneurysms has been explored recently but remains controversial. Objective: To compare traditional endovascular therapeutic approaches (coiling and stent-assisted coiling) and PED for DCCAs in a multicenter cohort of patients. Methods: A multicenter, retrospective cohort comparison study was conducted that included consecutive patients with unruptured DCCAs treated with either traditional endovascular therapeutic approaches or PED placement at three centers between 2016 and 2020. Propensity score matching analysis was applied to adjust for baseline risk factors between the PED and TET groups. Matching was based on age, sex, aneurysm size, location, morphology, adjunctive coiling, treatment history, and preoperative mRS score. Results: In total, 209 patients with DCCAs treated with PED or traditional endovascular therapeutic approaches were identified. Thirty-seven patients underwent PED treatment, and 172 patients underwent traditional endovascular therapeutic approaches. After propensity score matching, 37 aneurysm pairs were matched, and the baseline characteristics of the patients were balanced between the groups. The complete occlusion rate between PED and traditional endovascular therapeutic approach in both matched cohorts (91.7 vs. 92.3%, p > 0.78) was similar. The rate of periprocedural treatment-related complications in both the PED and traditional endovascular therapeutic groups was 13.5%. Univariate analysis identified average parent vessel diameter as the only predictor of complete occlusion (p = 0.038). Conclusions: PED is a viable option for treating DCCAs by providing occlusion and complication rates similar to those of traditional endovascular therapeutic approaches. A rigid patient selection procedure and proper planning should be undertaken to reduce treatment-related complications.

Fluoride enrichment mechanisms and related health risks of groundwater in the transition zone of geomorphic units, northern China.

Although groundwater is the primary drinking water source in northern of China, little is known about generation mechanisms and related health risks of high fluoride groundwater at the geomorphic transition zones. Thus, 419 groundwater samples were collected from Zhangjiakou region, where is a typically geomorphic transition zone of the North China Plain and the Inner Mongolia Plateau, to conduct the hydrochemical analysis, geochemical modeling, multivariate statistical analysis, and health risks assessment. From the results, F- concentration in groundwater had a range of 0.05-9.71 mg L-1. About 37.1% and 26.2% of groundwater samples from Bashang region (BSR) and Baxia region (BXR), respectively, were over the 1.50 mg L-1, which were mainly distributed in the groundwater flow retardation area and/or evaporation discharge area. Thermodynamic simulations demonstrated that F-bearing minerals dissolution and Ca2+/Mg2+ removal via calcite/dolomite precipitation primarily governed high-F- groundwater formation in the whole study area. Competitive adsorption, evaporation, evaporites dissolution and salt-effect also affected F- enrichment in BSR. Desorption in alkaline environment, ion exchange and human activities played a vital role in F- enrichment at BXR. The multivariate statistical analysis revealed that the origin of F- contamination was geogenic in BSR; whereas, it was geogenic and anthropogenic in BXR. Besides, more than 71.8%, 51.0%, 36.1% and 25.5% of the study area exceeded the acceptable level (health index>1) for infants, children, adult males, and females, respectively. The health risks for different groups of people varied significantly and ranked: infants > children > males > females, suggesting that younger people were more susceptible to fluoride contamination. Meanwhile, females were more resistant to fluoride contamination than males. These findings are vital to providing insights on high-F- groundwater formation, investigate the situation of health risks, and conduct the integrated management for high fluoride groundwater in geomorphic transition zones at northern China.

Automatic and Efficient Prediction of Hematoma Expansion in Patients with Hypertensive Intracerebral Hemorrhage Using Deep Learning Based on CT Images.

Patients with hypertensive intracerebral hemorrhage (ICH) have a high hematoma expansion (HE) incidence. Noninvasive prediction HE helps doctors take effective measures to prevent accidents. This study retrospectively analyzed 253 cases of hypertensive intraparenchymal hematoma. Baseline non-contrast-enhanced CT scans (NECTs) were collected at admission and compared with subsequent CTs to determine the presence of HE. An end-to-end deep learning method based on CT was proposed to automatically segment the hematoma region, region of interest (ROI) feature extraction, and HE prediction. A variety of algorithms were employed for comparison. U-Net with attention performs best in the task of segmenting hematomas, with the mean Intersection overUnion (mIoU) of 0.9025. ResNet-34 achieves the most robust generalization capability in HE prediction, with an area under the receiver operating characteristic curve (AUC) of 0.9267, an accuracy of 0.8827, and an F1 score of 0.8644. The proposed method is superior to other mainstream models, which will facilitate accurate, efficient, and automated HE prediction.

Pipeline for the treatment of distal cerebral circulation aneurysms: A multicenter study focusing on periprocedural Complications.

BACKGROUND AND AIM: Distal cerebral circulation aneurysms (DCCAs) remain treatment challenges for neurointervention. The off-label use of the pipeline embolization device (PED) for these aneurysms remains controversial. This study aimed to evaluate the safety and efficacy of PED for DCCAs in a multicenter cohort of patients. METHODS: Between March 2016 and June 2021, we retrospectively analyzed the neurointerventional data on the clinical and radiological records of all patients undergoing PED treatment of DCCAs at three medical centers. RESULTS: A total of 53 consecutive patients with 53 DCCAs were treated with PED. The mean aneurysm size was 12.3 ± 5.7 mm. In total, 75.4% (40/53) were fusiform and 24.5% (13/53) were saccular. Of these, 17.0% (9/53) were recurrent aneurysms that were previously treated with endovascular or microsurgical approaches. The technical success rate was 100%, among which 81.1% (43/53) procedures were completed with a single PED, and the rest (10/53, 18.8%) required telescoping with two devices. Angiographic follow-up data were available for 51 patients, with a median follow-up time of 12 months. At the latest follow-up, 46/51 (90.2%) aneurysms showed complete obliteration, and 4/51 (7.8%) showed reduced filling. Periprocedural complications such as hemorrhage were observed in two patients with MCA aneurysms (3.8%, 2/53), and ischemic events occurred in six patients (11.3%, 6/53). The overall mortality and morbidity rates were 7% (4/53). CONCLUSIONS: PED is a viable option for treating DCCAs, especially for recurrent aneurysms. Coverage of bifurcation branches and perforator may increase the risk of complications.

Using angiographic parametric imaging-derived radiomics features to predict complications and embolization outcomes of intracranial aneurysms treated by pipeline embolization devices.

BACKGROUND: Pipeline embolization devices (PEDs) have gained widespread popularity in the treatment of intracranial aneurysms (IAs). However, precise predictors of treatment outcomes are still lacking. This study aimed to use angiographic parametric imaging (API)-derived radiomics features to explore whether biomarkers extracted from immediate postprocedural digital subtraction angiography (DSA) were associated with complications and embolization outcomes of IAs treated with PED without adjunctive coils. METHODS: Radiomic features were extracted from postprocedural DSA by API, and radiomics feature selection and radiomics score calculation were performed by the least absolute shrinkage and selection operator (LASSO) logistic regression. Angiographic findings and clinical characteristics were screened using stepwise multivariable logistic regression analysis to identify significant variables for predicting the complication endpoint. Radiomics feature selection and radiomics risk score (RadRS) calculations were performed by LASSO Cox regression. Univariate and multivariate Cox regression analyses were used to identify significant predictors for the occlusion endpoint. RESULTS: We screened 281 observations for complications and 235 observations for embolization outcomes from IAs treated in our center using PED between June 2015 and July 2020. Multivariate regression analysis showed association of the radiomics score (p<0.01) and hypertension (p=0.04) with complications. RadRS (p<0.01), symptoms (p<0.01), and age (p=0.03) were predictors of embolization outcomes. Kaplan-Meier analysis revealed that symptomatic patients (p<0.01) and those with off-label IAs (p=0.03) had shorter intervals to complete occlusion. CONCLUSIONS: Biomarkers extracted from immediate postprocedural DSA by API could be potential indicators for assessing treatment outcomes of IAs treated by PED without adjunctive coils.