Gliomas are the most common primary brain tumors, and isocitrate dehydrogenase (IDH) mutation status is a critical molecular marker influencing prognosis and treatment planning. This study aimed to evaluate the value of a multiparametric magnetic resonance imaging (MRI) radiomics model in predicting IDH1 R132H immunopositivity status in patients with gliomas. A retrospective analysis was conducted on 94 adult glioma patients at Viet Duc University Hospital from June 2024 to January 2026. All patients underwent preoperative MRI including conventional sequences, diffusion-weighted imaging (DWI), and dynamic susceptibility contrast perfusion imaging (DSC-MRI). Radiomics features were extracted from apparent diffusion coefficient (ADC) and relative cerebral blood volume (rCBV) maps within the tumor region, followed by correlation filtering and LASSO (Least Absolute Shrinkage and Selection Operator)-based feature selection, retaining 5 ADC and 10 rCBV features for logistic regression model construction. The ADC-based model achieved an area under the curve (AUC) of 0.875, the rCBV-based model reached 0.943, and the combined model achieved the highest numerical AUC (0.955), with an accuracy of 89.5%, sensitivity of 87.5%, and specificity of 90.9%, although the differences between models were not statistically significant. These findings suggest that multiparametric MRI radiomics demonstrates promising discriminatory performance for preoperative prediction of IDH1 R132H immunopositivity status in glioma patients, although these estimates derive from a single-center cohort with a small held-out test set and therefore require external validation in larger, prospective cohorts.
Introduction Mechanical thrombectomy (MT) is an endovascular approach applicable to large- and medium-vessel occlusion in the context of ischemic stroke (IS), with recanalization rates superior to 80% and favorable clinical outcomes. However, its benefits in patients with pre-existing functional disability remain unclear because these individuals are typically excluded from randomized controlled trials (RCTs). This systematic review and meta-analysis therefore aimed to assess how pre-stroke functional status influences key prognostic outcomes after MT. Methodology PubMed, Embase, Scopus, Web of Science, and Cochrane Library databases were searched for English studies published from inception to September 2025. Observational cohorts and RCTs were included if they evaluated patients with IS treated with MT, comparing outcomes (functional outcomes, recanalization, complications, and mortality) between patients with and without pre-stroke disability (PD and NPD, respectively). Disability was mainly defined as a pre-stroke modified Rankin Scale (mRS) ≥2 or ≥3, and analyses were stratified accordingly. Data were pooled using a random-effects model, and heterogeneity was explored with Baujat plots and leave-one-out analyses. Results This review included 12 studies comprising 26,444 patients, of whom 2,837 had PD and 23,607 had NPD. Most studies defined PD as a pre-stroke mRS ≥3. Patients with PD had higher rates of diabetes (28.9% vs 18.5%), hypertension (78.9% vs 66.0%), and atrial fibrillation (46.7% vs 29.4%). In contrast, NIHSS, ASPECTS, occlusion site, and time to treatment were similar between groups. Intravenous thrombolysis was less frequently administered in the PD group (33.8% vs 46.9%). No significant difference was observed in favorable functional outcomes between patients with PD and NPD (OR = 0.68; 95% CI: 0.39–1.16). Otherwise, 90-day mortality was higher in PD patients (OR = 2.75; 95% CI: 2.38–3.18). Finally, the risk of symptomatic intracranial hemorrhage and the rate of successful recanalization did not differ significantly between groups (OR = 1.19; 95% CI: 0.98–1.43, and OR = 0.89; 95% CI: 0.71–1.11, respectively). Conclusion Pre-stroke disability was not significantly associated with functional outcomes or reduced recanalization rates after mechanical thrombectomy, although the substantial heterogeneity in functional outcomes warrants cautious interpretation. Pre-stroke disability was associated with higher 90-day mortality, which may be related to a greater baseline comorbidity burden and clinical vulnerability. These results support considering thrombectomy in selected patients with prior disability, while highlighting the need for individualized assessment. High-quality prospective studies are still required to confirm these findings.
Background Disproportionately enlarged subarachnoid-space hydrocephalus (DESH) has been proposed as a radiological predictor of shunt responsiveness in idiopathic normal pressure hydrocephalus (iNPH), but previous studies have reported inconsistent results. We investigated the association between preoperative DESH score and postoperative outcome after shunt surgery in a prospective iNPH cohort. Methods This prospective study included 101 consecutive patients with iNPH from the Gothenburg Prediction of Outcome in iNPH (POiNT) study. Preoperative DESH scores were assessed on MRI using previously published criteria. Clinical outcomes included the Gothenburg iNPH scale, modified Rankin Scale (mRS), Mini-Mental State Examination (MMSE), and Timed Up and Go test (TUG-t). The primary outcome was improvement of ≥5 points on the iNPH scale. Results Mean preoperative DESH score was 6.3 ± 1.7. At follow-up, the mean iNPH scale score improved from 50.8 ± 19.8 to 63.3 ± 20.0 ( p < .001), with 70% improving by ≥5 points. Preoperative DESH score was not associated with postoperative change in iNPH scale score ( r = −0.123, p = .219) or with responder status for any outcome. In multivariable analysis, DESH score was not independently associated with postoperative iNPH scale score after adjustment for baseline iNPH scale score, age, and disease duration. DESH score and Evans’ index decreased and callosal angle increased after surgery (all p < .001). Conclusions Preoperative DESH score was not associated with postoperative clinical improvement after shunt surgery in patients with iNPH. Although DESH-related imaging markers changed significantly after surgery, baseline DESH score had limited value as an independent predictor of shunt responsiveness.
Hybrid 2-[18F]-fluoro-2-deoxy-D-glucose positron emission tomography/magnetic resonance imaging (18F-FDG PET/MRI) enables simultaneous, single-session assessment of structural and metabolic stroke damage. We prospectively studied 10 consecutive patients (6 women; mean age 71.6 ± 11.2 years) with anterior-circulation stroke due to middle cerebral artery (MCA) occlusion who underwent successful mechanical thrombectomy (MT). Structural damage was graded with the Alberta Stroke Program Early CT Score (ASPECTS) on admission and 24-h non-contrast CT and on diffusion-weighted imaging (DWI) and fluid-attenuated inversion recovery (FLAIR) at 72 hours; metabolic damage was graded with a PET-adapted ASPECTS on simultaneously acquired 18F-FDG PET at 72 hours. A between-modality difference of ≥3 ASPECTS points was considered significant. Baseline ASPECTS was 10 in 9 patients, and all achieved successful recanalization (modified Thrombolysis in Cerebral Infarction 2c-3). 18F-FDG PET showed severe hypometabolism in every infarcted territory, often extending beyond structural changes: ASPECTS differences were present in 7/10 patients for CT, 6/10 for DWI and 6/10 for FLAIR versus 18F-FDG PET/MRI, reaching the predefined 3-point threshold in 3/10 for CT versus PET/MRI. Because DWI, FLAIR and PET were acquired simultaneously at 72 hours (CT at 24 hours), the DWI/FLAIR-versus-PET comparisons are free of temporal confounding. Ipsilateral thalamic and crossed cerebellar diaschisis were each identified in 4/10 patients at 72 hours. Despite this more extensive hypometabolism, 9/10 patients achieved a favorable outcome (modified Rankin Scale ≤2) at 3 months. Hybrid 18F-FDG PET/MRI maps metabolic abnormality and remote network dysfunction invisible to structural imaging alone, adding a physiological dimension to ASPECTS-based evaluation of the reperfused brain.
Magnetic resonance spectroscopy (MRS) is a noninvasive imaging technique that complements conventional magnetic resonance imaging by providing in vivo metabolic and biochemical characterization of brain tissue. By quantifying metabolites such as N-acetylaspartate, choline, creatine, lactate, and myo-inositol (myo-Ins), MRS offers insight into neuronal integrity, membrane turnover, energy metabolism, inflammation, and necrosis, features that help distinguish between pathologies with greater specificity than anatomic imaging alone. This review presents a clinically focused, systematic approach to brain MRS, addressing indications, acquisition strategies, spectral interpretation, and characteristic metabolic patterns across a broad spectrum of neuropathologies. Key technical factors influencing spectral quality and reproducibility, such as voxel selection, field strength, echo time, and sequence choice, are highlighted. Metabolic signatures of neoplastic, infectious, inflammatory, demyelinating, metabolic, and neurodegenerative disorders are reviewed with an emphasis on practical differentiation in the setting of overlapping imaging appearances. Recognizing the limited specificity of isolated metabolite abnormalities, this review emphasizes integration of MRS findings with clinical context and conventional MRI. A structured interpretive framework is proposed to promote consistent analysis and enhance diagnostic confidence, reinforcing the role of MRS as a valuable adjunct in contemporary neuroradiologic practice.
