The summary cerebral small-vessel disease (CSVD) score reflects brain-damage severity, but its relationship with white-matter (WM) integrity and cerebral perfusion remains unclear. Here, we aimed to explore how this score links WM microstructure and cerebral blood flow (CBF). We included 31 patients with CSVD and mild cognitive impairment (CSVD-MCI) and 31 matched healthy controls. Diffusion kurtosis imaging (DKI) and three-dimensional arterial spin labeling were used with tract-based spatial statistics to assess group differences in axial kurtosis, mean kurtosis (MK), radial kurtosis (RK) and CBF. Pearson and Spearman correlation analyses and mediation effects analyses were performed. CSVD-MCI patients showed widespread WM damage and reduced CBF. In the bilateral superior corona radiata (SCR), the summary CSVD score was negatively correlated with MK, RK, and CBF, whereas MK and RK were positively correlated with CBF. Mediation analysis revealed that the summary CSVD score statistically accounted for indirect effects of CBF on MK and RK in the SCR. In CSVD-MCI, reduced CBF, higher cumulative lesion burden, and WM microstructural damage were linked in a tract-specific pattern. The summary CSVD score statistically accounted for part of the association between CBF and DKI-derived WM metrics in the SCR, supporting its role as an imaging marker that integrates vascular and structural injury.
To evaluate the real-world diagnostic accuracy and systematic misclassification patterns of a deep learning algorithm (Hevi AI) for detecting intracranial hemorrhage (ICH) on non-contrast head computed tomography (CT) within a single-center cohort. This retrospective, single-center study included 1,617 emergency non-contrast head CT examinations. Two expert radiologists served as the reference standard. The algorithm’s binary detection performance (sensitivity, specificity, negative predictive value [NPV]) and subtyping accuracy were analyzed. Statistical analyses evaluated age and sex differences between false-positive (FP) and true-negative (TN) cases. The reference standard ICH prevalence was 13.4
Probable idiopathic normal pressure hydrocephalus (pNPH) is a potentially treatable neurological disorder that can be difficult to differentiate from diffuse cerebral atrophy because of overlapping clinical and imaging features. This study evaluated the diagnostic performance of a novel magnetic resonance imaging (MRI)-derived marker, the sylviocentral ratio, for distinguishing pNPH from diffuse cerebral atrophy. In this prospective study, 72 patients (36 with pNPH and 36 with diffuse cerebral atrophy) underwent routine brain MRI, with an additional sagittal 3D T2-weighted SPACE acquisition; axial and coronal reformatted images were generated from the volumetric dataset for standardized measurements. Sylvian fissure and central sulcus diameters were measured on these standardized images using predefined anatomical landmarks, and the sylviocentral ratio was calculated. The sylviocentral ratio was significantly higher in patients with pNPH than in those with diffuse cerebral atrophy (10.94 ± 4.67 vs. 2.86 ± 2.00, p < 0.001). Receiver operating characteristic (ROC) analysis demonstrated excellent diagnostic performance, with an area under the curve (AUC) of 0.953 (95
To compare perfusion parameters of glioblastomas and primary central nervous system lymphomas (PCNSL) using CT perfusion (CTP) and to assess the diagnostic performance of this technique for their preoperative differential diagnosis. This single-center retrospective study included CTP data from 122 patients (57 with PCNSL and 65 with glioblastoma) examined at our hospital between 2006 and 2026. All diagnoses were histologically verified; no patient received chemotherapy, corticosteroids or radiotherapy prior to CTP. Imaging was performed on a 64-slice Optima 660 scanner (GE Medical Systems) using a prolonged perfusion protocol. Absolute (CBF, CBV, MTT, PS) and normalized (nCBF, nCBV, nMTT, nPS) perfusion parameters were obtained. The Mann–Whitney U test, Spearman correlation and ROC analysis were applied for statistical comparison. Glioblastomas demonstrated significantly higher CBF and CBV and lower MTT and PS values than PCNSL; the same pattern was observed for the normalized parameters. PS (AUC = 0.93), nPS (AUC = 0.90), nCBF (AUC = 0.91), nCBV (AUC = 0.90), CBF (AUC = 0.88) and CBV (AUC = 0.88) showed the highest diagnostic performance, whereas MTT and nMTT were less informative (AUC = 0.69–0.72). CTP is a highly informative non-invasive quantitative imaging tool for the preoperative differentiation of glioblastomas and PCNSL. The inclusion of normalized perfusion parameters improves reproducibility and supports use in routine clinical practice and multicenter studies. CTP can be recommended whenever conventional CT and MRI fail to reliably distinguish these tumors.
Pial arteriovenous fistulas (PAVFs) are rare high-flow vascular lesions requiring precise characterization of the fistulous angioarchitecture before treatment. We report a pediatric PAVF in which an enlarged artery adjacent to the fistula initially appeared suspicious for additional fistulous supply. Superselective angiography demonstrated normal cortical arterial arborization and parenchymal perfusion without early venous drainage, confirming that the enlarged vessel did not participate directly in the arteriovenous shunt. Selective coil embolization achieved complete immediate occlusion of the fistulous communication while preserving the adjacent normal cortical arterial supply. This case illustrates that arterial enlargement alone does not establish participation in a PAVF and highlights an angiographic pitfall relevant to treatment planning.
