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Background: Global brain health has gained increasing attention recently. Imaging markers of brain frailty have been related to functional outcomes in previous studies on anterior circulation; however, little data are available on imaging markers and posterior circulation. Purpose: To investigate the impact of brain frailty on functional outcomes in patients with acute perforating artery infarction (PAI) of the posterior circulation. Study Type: Prospective. Population: One hundred patients (60.78 ± 9.51 years, 72% men) with acute posterior circulation PAI (determined by diffusion‐weighted magnetic resonance imaging (MRI)/time‐of‐flight MR angiography). Field Strength/Sequence: T1‐ and T2‐weighted fast spin echo, T2‐weighted fluid‐attenuated inversion recovery, diffusion‐weighted echo planar, gradient echo (susceptibility‐weight imaging), and 3D time‐of‐flight MR angiography sequences at 3.0 T. Assessment: Periventricular and deep white matter hyperintensities (WMH), enlarged perivascular spaces (EPVS) in the basal ganglia and centrum semiovale area, lacunes, cerebral microbleeds (CMB), and total brain frailty score by calculating the above imaging characters were rated visually by three radiologists with 9, 10, and 11 years of experience and one neuroradiologist with 12. Infarction volume was assessed using baseline diffusion‐weighted imaging (DWI) data obtained within 24 hours of symptom onset. A modified Rankin Scale (mRS) score >1 on day 90 defined an adverse functional outcome. Associations between the imaging markers of brain frailty and functional outcomes were assessed. Statistical Tests: Fisher's exact test, Mann–Whitney U test, and multivariable binary logistic regression. A P value <0.05 was considered statistically significant. Results: Adverse prognoses (mRS > 1) were observed in 34 (34%) patients. Infarction volume, periventricular WMH, deep WMH, basal ganglia EPVS, CMB, and the brain frailty score were significantly associated with adverse functional outcomes. An increased brain frailty score was significantly associated with unfavorable mRS score on day 90 (odds ratio 1.773, 95% confidence interval 1.237–2.541). Data Conclusion: Advanced MRI imaging markers of brain frailty, individually or combined as a total brain frailty score, were associated with worse functional outcomes after acute posterior circulation PAI. Level of Evidence: 3 Technical Efficacy: Stage 3 [ABSTRACT FROM AUTHOR]

Background: Arterial spin labeling (ASL) has shown potential for the assessment of penumbral tissue in patients with acute ischemic stroke (AIS). The postlabeling delay (PLD) parameter is sensitive to arterial transit delays and influences cerebral blood flow measurements. Purpose: To assess the impact of ASL acquisition at different PLDs for penumbral tissue quantification and to compare their performance regarding assisting patient selection for endovascular treatment with dynamic susceptibility contrast MRI (DSC‐MRI) as the reference method. Study Type: Retrospective. Population: A total of 53 patients (59.98 ± 12.60 years, 32% women) with AIS caused by internal carotid or middle cerebral artery occlusion. Field Strength/Sequence: A 3‐T, three‐dimensional pseudo‐continuous ASL with fast‐spin echo readout. Assessment: Hypoperfusion volume was measured using DSC‐MRI and ASL with PLDs of 1.500 msec and 2.500 msec, respectively. Eligibility for endovascular treatment was retrospectively determined according to the imaging criteria of the Endovascular Therapy Following Imaging Evaluation for Ischemic Stroke trial (DEFUSE 3). Statistical Tests: Kruskal–Wallis tests, Bland–Altman plots, Cohen's kappa, and receiver operating characteristic analyses were used. The threshold for statistical significance was set at P ˂ 0.05. Results: Hypoperfusion volume for ASL with a PLD of 1.500 msec was significantly larger than that for DSC‐MRI, while the hypoperfusion volume for a PLD of 2.500 msec was not significantly different from that of DSC‐MRI (P = 0.435). Bland–Altman plots showed that the mean volumetric error between the hypoperfusion volume measured by DSC‐MRI and ASL with PLDs of 1.500/2.500 msec was −107.0 mL vs. 4.49 mL. Cohen's kappa was 0.679 vs. 0.773 for DSC‐MRI and ASL, respectively, with a PLD of 1.500/2.500 msec. The sensitivity and specificity for ASL with a PLD of 1.500/2.500 msec in identifying patients eligible for treatment were 89.74% vs. 97.44% and 92.86% vs. 64.29%, respectively. Data Conclusion: In AIS, PLDs for ASL acquisition may have a considerable impact on the quantification of the hypoperfusion volume. Evidence Level: 3 Technical Efficacy: Stage 2 [ABSTRACT FROM AUTHOR]

The histological appearance of NTRK-rearranged spindle cell neoplasms is similar to several other kinds of soft tissue tumors or central nervous system tumors. Neurotrophic tyrosine receptor kinase (NTRK)-rearranged spindle cell neoplasm is a rare soft tissue tumor defined by molecular features. Our findings could expand the understanding of NTRK-rearranged spindle cell neoplasms in the central nervous system and provide more evidence for the future differential diagnosis of such tumors. [Extracted from the article]

Numerous studies have indicated an association between migraine and right-to-left shunt. However, little is known about whether right-to-left shunt has an effect on the migraine brain. This observational study aims to explore the impact of right-to-left shunt on the brain of migraine without aura on microstructural level. Thirty-five patients with migraine without aura were enrolled in this study. Contrast-enhanced Transcranial Doppler was performed to evaluate the status of right-to-left shunt. Three-dimensional T1-weighted and diffusion tensor images were acquired for data analysis. We employed voxel-based morphometry and tract-based spatial statistical analyses to assess the differences of gray and white matter between migraineurs with and without right-to-left shunt, respectively. Among the 35 patients, 19 (54.3%) patients had right-to-left shunt. There were no significant differences in headache features between migraineurs with and without right-to-left shunt. There were significant increases of mean and radial diffusivity in migraineurs with right-to-left shunt compared with migraineurs without right-to-left shunt. The alterations were primarily located in the right posterior thalamic radiation, secondly in the body of corpus callosum and the right superior corona radiata. No significant differences were observed in values of fractional anisotropy and axial diffusivity. No significant between-group differences were found in gray matter volume. Right-to-left shunt may cause alterations of white matter integrity in migraine without aura, and the alterations are more likely to be located at the posterior circulation. [ABSTRACT FROM AUTHOR]

Objectives. Magnetic resonance imaging (MRI) is pivotal in diagnosing brain injuries in infants. However, the dynamic development of the brain introduces variability in infant MRI characteristics, posing challenges for MRI-based classification in this population. Furthermore, manual data selection in large-scale studies is labor-intensive, and existing algorithms often underperform with thick-slice MRI data. To enhance research efficiency and classification accuracy in large datasets, we propose an advanced classification model. Approach. We introduce the Dual-Branch Attention Information Interactive Neural Network (DBAII-Net), a cutting-edge model inspired by radiologists' use of multiple MRI sequences. DBAII-Net features two innovative modules: (1) the convolutional enhancement module (CEM), which leverages advanced convolutional techniques to aggregate multi-scale features, significantly enhancing information representation; and (2) the cross-modal attention module (CMAM), which employs state-of-the-art attention mechanisms to fuse data across branches, dramatically improving positional and channel feature extraction. Performances (accuracy, sensitivity, specificity, area under the curve (AUC), etc) of DBAII-Net were compared with eight benchmark models for brain MRI classification in infants aged 6 months to 2 years. Main results. Utilizing a self-constructed dataset of 240 thick-slice brain MRI scans (122 with brain injuries, 118 without), DBAII-Net demonstrated superior performance. On a test set of approximately 50 cases, DBAII-Net achieved average performance metrics of 92.53% accuracy, 90.20% sensitivity, 94.93% specificity, and an AUC of 0.9603. Ablation studies confirmed the effectiveness of CEM and CMAM, with CMAM significantly boosting classification metrics. Significance. DBAII-Net with CEM and CMAM outperforms existing benchmarks in enhancing the precision of brain MRI classification in infants, significantly reducing manual effort in infant brain research. Our code is available athttps://github.com/jiazhen4585/DBAII-Net., (© 2024 Institute of Physics and Engineering in Medicine. All rights, including for text and data mining, AI training, and similar technologies, are reserved.)

Aims: Our purpose is to assess the role of cerebral small vessel disease (SVD) in prediction models in patients with different subtypes of acute ischemic stroke (AIS)., Methods: We enrolled 398 small-vessel occlusion (SVO) and 175 large artery atherosclerosis (LAA) AIS patients. Functional outcomes were assessed using the modified Rankin Scale (mRS) at 90 days. MRI was performed to assess white matter hyperintensity (WMH), perivascular space (PVS), lacune, and cerebral microbleed (CMB). Logistic regression (LR) and machine learning (ML) were used to develop predictive models to assess the influences of SVD on the prognosis., Results: In the feature evaluation of SVO-AIS for different outcomes, the modified total SVD score (Gain: 0.38, 0.28) has the maximum weight, and periventricular WMH (Gain: 0.07, 0.09) was more important than deep WMH (Gain: 0.01, 0.01) in prognosis. In SVO-AIS, SVD performed better than regular clinical data, which is the opposite of LAA-AIS. Among all models, eXtreme gradient boosting (XGBoost) method with optimal index (OI) has the best performance to predict excellent outcome in SVO-AIS. [0.91 (0.84-0.97)]., Conclusions: Our results revealed that different SVD markers had distinct prognostic weights in AIS patients, and SVD burden alone may accurately predict the SVO-AIS patients' prognosis., (© 2023 The Authors. CNS Neuroscience & Therapeutics published by John Wiley & Sons Ltd.)