Enhanced vessel wall magnetic resonance imaging in the follow-up of intracranial aneurysms treated with flow diversion.

OBJECTIVE: This study aimed to compare the efficacy of enhanced 3D T1-weighted black-blood fast-spin-echo vessel wall magnetic resonance imaging (eVW-MRI) and time-of-flight magnetic resonance angiography (TOF MRA) for follow-up evaluation of aneurysms treated with flow diversion (FD). METHODS: Our study enrolled 77 patients harboring 84 aneurysms treated with FD. Follow-up was by MRI (eVW-MRI and TOF MRA) and digital subtraction angiography (DSA). Two radiologists, blinded to DSA examination results, independently evaluated the images of aneurysm occlusion and parent artery patency using the Kamran-Byrne Scale. Interobserver diagnostic agreement and intermodality diagnostic agreement were acquired. Pretreatment and follow-up aneurysm wall enhancement (AWE) patterns were collected. RESULTS: Based on the Kamran-Byrne Scale, the intermodality agreement between eVW-MRI and DSA was better than TOF MRA versus DSA for aneurysm remnant detection (weighted ĸ = 0.891 v. 0.553) and parent artery patency (ĸ = 0.950 v. 0.221). Even with the coil artifact, the consistency of eVW-MRI with DSA for aneurysm remnant detection was better than that of TOF MRA (weighted ĸ = 0.891 v. 0.511). The artifact of adjunctive coils might be more likely to affect the accuracy in evaluating parent artery patency with TOF MRA than with eVW-MRI (ĸ = 0.077 v. 0.788). The follow-up AWE patterns were not significantly associated with pretreatment AWE patterns and aneurysm occlusion. CONCLUSIONS: The eVW-MRI outperforms TOF MRA as a reliable noninvasive and nonionizing radioactive imaging method for evaluating aneurysm remnants and parent artery patency after FD. The significance of enhancement patterns on eVW-MRI sequences needs more exploration. CLINICAL RELEVANCE STATEMENT: The application of enhanced vessel wall magnetic resonance imaging has proven to be a promising tool to depict aneurysm remnant and parent artery stenosis in order to tailor the antiplatelet therapy strategy in patients after flow diversion. KEY POINTS: • Enhanced vessel wall magnetic resonance imaging has an emerging role in depicting aneurysm remnant and parent artery patency after flow diversion. • With or without the artifact from adjunctive coils, enhanced vessel wall magnetic resonance imaging was better than TOF MRA in detecting aneurysm residual and parent artery stenosis by using DSA imaging as the standard. • Enhanced vessel wall magnetic resonance imaging holds potential to be used as an alternative to DSA for routine aneurysm follow-up after flow diversion.

Randomized, prospective, multicenter trial assessing the numen coil embolization system in the endovascular treatment of small intracranial aneurysms: outcomes from the CATCH Trial.

BACKGROUND AND PURPOSE: The CATCH (Coil Application Trial in China) trial was designed to assess the safety and efficacy of the Numen Coil Embolization System in the treatment of intracranial aneurysms in comparison with the Axium coil (ev3/Medtronic). Although the endovascular treatment of small (< 5 mm) intracranial aneurysms has been reported with favorable long-term clinical and angiographic outcomes, randomized trials are still lacking. Data for aneurysms smaller than 5 mm were extracted from the CATCH trial. MATERIALS AND METHODS: A randomized, prospective, multicenter trial was conducted at ten centers throughout China. Enrolled subjects with small intracranial aneurysms were randomly assigned to receive treatment with the Numen Coil or the Axium coil. The primary outcome was successful aneurysm occlusion at the 6-month follow-up. In contrast, the secondary outcomes included complete aneurysm occlusion, recurrence rate, clinical deterioration, and safety data at the 6-month and 12-month follow-ups. RESULTS: A total of 124 patients were enrolled in the study. Overall, 58 patients were assigned to the Numen group, and 66 were assigned to the Axium group. At the 6-month follow-up, the successful aneurysm occlusion rate was 93.1% (54/58) in the MicroPort NeuroTech group and 97.0% (64/66) in the Axium group, with a common odds ratio of 0.208 (95% confidence interval, 0.023-1.914; P = 0.184). Complications were comparable between the groups. CONCLUSIONS: Compared with the Aixum coil, the Numen coil is safe and effective in treating small intracranial aneurysms. TRIAL REGISTRATION: (13/12/2016, NCT02990156).

Safety and efficacy of endovascular treatment for tiny ruptured intracranial aneurysms with low-profile visualized intraluminal support stents.

BACKGROUND: Endovascular treatment for tiny ruptured intracranial aneurysms is known to be technically challenging. Thus, we aimed to investigate the safety and efficacy of low-profile visualized intraluminal support (LVIS) stents in the treatment of tiny ruptured intracranial aneurysms. METHODS: From April 2014 to June 2019, among 90 patients with tiny ruptured aneurysms who were treated at our institution endovascularly, 28 underwent stent-assisted coiling with LVIS stents. The clinical and angiographic results were reviewed. RESULTS: In the LVIS group, complete occlusion was achieved in 27 patients (96.4%). Intraprocedural thrombus formation occurred in 3 patients (10.7%). Follow-up angiography in 24 patients at 6-12 months showed complete occlusion in 23 patients (95.8%) and no aneurysm recurrence. In the coiling-only group, complete occlusion was achieved in 58 patients (93.5%). Intraprocedural aneurysm rupture occurred in 2 patients (3.2%), and postprocedural ischemia occurred in 4 patients (6.5%), with a complication rate of 9.7%. Follow-up angiography in 52 patients at 6-12 months showed complete occlusion in 43 patients (82.7%) and aneurysm recurrence in 7 patients (9.2%). No significant (p > 0.05) differences existed between the two groups. CONCLUSIONS: The LVIS stent is safe and effective in the treatment of tiny ruptured intracranial aneurysms.

Morphometric Measurements of the C1 Lateral Mass with Congenital Occipitalization of the Atlas.

OBJECTIVE: Unfamiliarity with the morphometry of the assimilated C1 lateral mass (C1LM) could make screw placement dangerous. In the present study, we defined the morphometric dimensions of the occipitalized C1LM to provide surgeons with valuable information for preoperative planning. METHODS: Thin-slice computed tomography scanning data from 131 patients with occipitalization of the atlas (OA) and 50 control cases were imported into Mimics software for analysis. The widths and heights of the C1LM were fully measured in the different planes. The ideal inward angulation and the safe maximum cephalic angulation of C1 screw trajectory were evaluated. RESULTS: Except for the medial height, all the widths and heights of C1LM were significantly shorter in the OA group than those in the control group. The ideal inward angle (α) was significantly larger in the OA group (23.8° ± 8.3°) than that (15.3° ± 3.8°) in the control group; the corresponding screw length was also significantly longer in the OA group (20.9 ± 2.9 mm). The safe maximum cephalic angles (ß) of the screw trajectory did not reach a significant difference between the 2 groups. All the widths and heights were shorter in the females than those in the males. The α angle also did not reach a significant difference between the sexes; however, the ß angles in the males (35.9° ± 10.4°) was significantly larger than that in the females (32.0° ± 9.4°). CONCLUSIONS: Although the hypoplastic C1LM brings limitations to screw insertion to some extent, it is still broad enough to accommodate a screw safely in both female and male patients. Considering the irregularity of the C1LM in patients with OA, the preoperative imaging assessment is critical, and C1LM screw placement should be performed individually.

Altered emotional prosody processing in patients with Parkinson's disease after subthalamic nucleus stimulation.

BACKGROUND: Patients with Parkinson's disease (PD) exhibit deficits in recognizing and expressing vocal emotional prosody. The aim of this study was to explore emotional prosody processing in patients with PD shortly after subthalamic nucleus (STN) deep brain stimulation (DBS). METHODS: Two groups of patients with PD (pre-DBS and post-DBS) and one healthy control (HC) group were recruited as participants. All participants (PD and HC) were assessed using the Montreal Affective Voices database 50 Voices Recognition test. All participants were asked to nonverbally express five basic emotions (happiness, anger, fear, sadness, and neutral) to test emotional prosody expression. Fifteen native Chinese speakers were recruited as raters. We recorded the accuracy rate, reaction time, confidence level, and two acoustic parameters (mean pitch and mean intensity). RESULTS: The PD groups scored lower than the HC group in recognizing and expressing emotional prosody. STN DBS had no significant effect on the recognition of emotional prosody but had a significant effect on fear prosody expression. Pearson's correlation analysis revealed significant correlations between performance on emotional prosody recognition tests and performance on emotional prosody expression tests in both the pre-DBS PD and post-DBS PD groups. CONCLUSION: Shortly after STN DBS, the ability to recognize emotional prosody was not altered, but fear expression was impaired. We identified associations between abnormalities in emotional prosody recognition and expression deficits both before and after STN DBS, indicating that the processes involved in recognizing and expressing emotional prosody may share a common system.

Altered emotional recognition and expression in patients with Parkinson's disease.

BACKGROUND: Parkinson's disease (PD) patients exhibit deficits in emotional recognition and expression abilities, including emotional faces and voices. The aim of this study was to explore emotional processing in pre-deep brain stimulation (pre-DBS) PD patients using two sensory modalities (visual and auditory). METHODS: Fifteen PD patients who needed DBS surgery and 15 healthy, age- and gender-matched controls were recruited as participants. All participants were assessed by the Karolinska Directed Emotional Faces database 50 Faces Recognition test. Vocal recognition was evaluated by the Montreal Affective Voices database 50 Voices Recognition test. For emotional facial expression, the participants were asked to imitate five basic emotions (neutral, happiness, anger, fear, and sadness). The subjects were required to express nonverbal vocalizations of the five basic emotions. Fifteen Chinese native speakers were recruited as decoders. We recorded the accuracy of the responses, reaction time, and confidence level. RESULTS: For emotional recognition and expression, the PD group scored lower on both facial and vocal emotional processing than did the healthy control group. There were significant differences between the two groups in both reaction time and confidence level. A significant relationship was also found between emotional recognition and emotional expression when considering all participants between the two groups together. CONCLUSION: The PD group exhibited poorer performance on both the recognition and expression tasks. Facial emotion deficits and vocal emotion abnormalities were associated with each other. In addition, our data allow us to speculate that emotional recognition and expression may share a common system.

Preoperative Prediction of Location and Shape of Facial Nerve in Patients with Large Vestibular Schwannomas Using Diffusion Tensor Imaging-Based Fiber Tracking.

OBJECTIVE: Preserving the facial nerve (FN) during surgery for large vestibular schwannomas (VSs) is challenging because of the unpredictable locations and morphologic changes in the FN. Diffusion tensor imaging-based fiber tracking (DTI-FT) has been proposed to preoperatively visualize the FN. This study was performed to evaluate the efficacy of DTI-FT for predicting FN location and shape in patients with large VSs. METHODS: In this prospective study, imaging data from 30 consecutive patients with large VSs were obtained using 3-T magnetic resonance imaging. The DTI-FT results included the location of the reconstructed FN relative to the tumor, and maximal fractional anisotropy (MFA) threshold values for FN tracking were determined with iPlan software. Intraoperative findings including the location of FN relative to the tumor and shape were determined by microscopic observations and electrophysiologic monitoring. A correlation analysis was performed between the DTI-FT results and intraoperative findings. RESULTS: Preoperative visualization of the FN using DTI-FT was successful in all 30 patients. The location of the cisternal segment of the FN in relation to the tumors predicted by DTI-FT was consistent with the intraoperative findings in 29 (96.7%) of the 30 patients. The area under the curve of MFA for differentiation between the compact and flat FN was 0.84 (95% confidence interval [CI]: 0.69-0.98) (P = 0.002). CONCLUSIONS: DTI-FT with modified tracking settings was useful to preoperatively predict the location of FN in patients with large VSs. The MFA of FN demonstrated moderate diagnostic performance for distinguishing compact from flat FNs.

Quantitative Measurements of the Skull Base and Craniovertebral Junction in Congenital Occipitalization of the Atlas: A Computed Tomography-Based Anatomic Study.

OBJECTIVE: To study the craniovertebral junction and determine the anatomic characteristics of occipitalization of the atlas (OC) by computed tomography (CT) imaging. METHODS: We retrospectively reviewed 80 cases of patients with OC who underwent cervical CT scanning between March 2012 and March 2014. Forty healthy subjects were recruited as a control cohort. Fusion pattern and associated osseous anomalies were recorded. Fifteen linear quantitative parameters were measured to study the outlet of the foramen magnum, angular dimension of the skull base, posterior cranial fossa, and height of the odontoid process. RESULTS: The most common fusion pattern was the complete osseous fusion (83.75%). Fifty-four patients (67.5%) presented with other osseous anomalies. Measurements of the OC group, such as the length of the clivus, cranial canal angle, and height of the odontoid process, were significantly different than those of the control group. The correlation analysis showed that the C1 lateral facet inclination was significantly correlated with the age of onset. CONCLUSIONS: The outlet of the foramen magnum is severely impaired in patients with OC, and the presence of other osseous anomalies is common. Deformity is not confined to the region of the assimilated atlas; the clivus and odontoid process are also shorter than normal. The lateral facet inclination likely influences disease progression.