The aim of the study was to investigate whether the ventriculoperitoneal (VP) shunt valve setting can be reliably assessed using maximum intensity projection (MIP) reconstructions from non-contrast, full-dose head CT scans, and how this method performs in comparison to conventional lateral skull radiographs. This retrospective study included 41 adult patients (mean age 59 ± 25 years) with Codman Certas programmable VP shunt valves who underwent lateral skull X‑ray and a same-day, non-contrast head CT scan between January and July 2024. From the CT data, MIP reconstructions of the valve region were generated. Three neuroradiologists, blinded to each other’s assessments, independently rated valve settings and image quality using a 5-point Likert scale. Mean reconstruction time was recorded. Radiation dose data were extracted from institutional dose-monitoring software. Valve settings were identifiable in all 44 CT/X-ray image pairs, with 95

The role of balloon guide catheters (BGC) in endovascular thrombectomy for acute ischemic stroke remains controversial, with conflicting evidence regarding clinical outcomes. We evaluated the impact of BGC use on periprocedural metrics and early neurological improvement (ENI). In this retrospective study, 541 patients with anterior circulation large vessel occlusion (intracranial ICA/M1/M2) undergoing endovascular thrombectomy at a tertiary stroke center (2018–2025) were 1:1 propensity-score-matched based on baseline characteristics (BGC+ [n = 91] vs. BGC- [n = 91]). Primary outcome was ENI (NIHSS reduction ≥ 8 points at 24 h or NIHSS < 2 at discharge). Secondary outcomes included reperfusion efficacy (groin-to-reperfusion time, first-pass effect [FPE], reperfusion grade), safety outcomes (any intracranial hemorrhage), in-hospital mortality, and length of hospital stay. BGC use was associated with higher FPE (52

PurposeThe standard modality for the diagnosis of ventriculoperitoneal (VP) shunt failure is the radiographic shunt series (RSS). However, ultra-low dose computed tomography (ULD-CT) may replace RSS. The aim of this study was to compare the radiation doses of RSS and ULD-CT in the diagnosis of mechanical shunt failure in human phantoms including pediatric phantoms and to further reduce the total CT dose by reducing the topogram radiation.MethodsMechanical VP shunt complications were placed on human phantoms representing ages of 1, 5, 10 and 30 years. RSS and ULD-CT were performed on each phantom with different radiation doses of the topogram with varying tube currents (10, 20, 30, 40 and 50 mAs). Effective doses of RSS and ULD-CT were estimated by using conversion factors.ResultsULD-CT demonstrated lower effective doses than RSS in phantoms representing ages 5, 10 and 30 years, while successfully depicting all mechanical shunt complications. However, higher effective doses were assessed for ULD-CT scans of the 1-year phantom than RSS. The effective doses for RSS and ULD-CT (utilizing 10 mAs topograms), respectively, were estimated as follows: 1-year: 0.056 vs. 0.133 mSv; 5-year: 0.186 vs. 0.123 mSv; 10-year: 0.240 vs. 0.107 mSv; 30-year: 0.641 vs. 0.076 mSv.ConclusionThis study demonstrated ULD-CT as an alternative to RSS for the detection of mechanical VP shunt complications, reducing radiation doses in phantoms equivalent to 5 years of age and older while demonstrating the complications equally to RSS. This may be of clinical interest, especially in children due to the reduction of radiation risks.

BACKGROUND/OBJECTIVE:Perimesencephalic subarachnoid haemorrhage (pmSAH) has traditionally been considered benign and of venous origin. However, advanced imaging increasingly identifies basilar artery perforator aneurysms (BAPAs) as a subset of cases historically labelled as non-aneurysmal, atraumatic (NAA) pmSAH. The objective was to compare clinical characteristics and outcomes of patients with NAA, BAPA and ruptured posterior circulation aneurysms (r-pc-AN), assessing the impact of pmSAH aetiology on patient outcomes. METHODS:This retrospective, multicentre, observational cohort study included BAPA cases from the international PERForator Aneurysm registry (2013-2025, 60 centres, 19 countries). Comparison cohorts were from a single high-volume tertiary care centre (2004-2025). The study included 444 patients (n=167 NAA, n=157 BAPA, n=120 r-pc-AN). Excellent outcome was defined as a modified Rankin Scale score of 0-1 at 3-6 months. RESULTS:Excellent outcomes were achieved in 137/167 (82%) of NAA, 96/140 (69%) of BAPA and 56/102 (55%) of r-pc-AN cohorts (p<0.001). Mortality rates were 1% (NAA), 11% (BAPA) and 18% (r-pc-AN). cCompared with BAPA, NAA patients had significantly higher odds of excellent outcome (adjusted OR, aOR 2.0, 95% CI 1.2 to 3.4, p=0.01), while r-pc-AN were associated with significantly lower odds of excellent outcome (aOR 0.5, 95% CI 0.3 to 0.9, p=0.01). Hydrocephalus and external ventricular drain rates were highest in r-pc-AN (83% and 87%), followed by BAPA (48% and 44%) and NAA (28% and 16%) (p<0.001). CONCLUSIONS:While pmSAH has been considered benign, our findings challenge this assumption. Patients with BAPA-related pmSAH demonstrated significantly worse outcomes than NAA but better outcomes than r-pc-AN. Further research is needed to distinguish BAPA-pmSAH from NAA-related pmSAH and to establish diagnostic and therapeutic guidelines. TRIAL REGISTRATION NUMBER:NCT06189014.

Objective: The use of recreational drugs such as alcohol and tetrahydrocannabinol(THC) is increasing worldwide. While tobacco and certain illicit substances are well-established risk factors for aneurysmal subarachnoid hemorrhage (aSAH), the role of alcohol and THC remains less well defined. Understanding their potential impact on aneurysm rupture and clinical severity could have significant implications for prevention and patient management. This study aimed to investigate the influence of alcohol and THC use on the risk of intracranial aneurysm(IA) rupture and the clinical severity of aSAH. Methods: We prospectively included 954 patients with IA treated at a tertiary center in Germany between 2016 and 2023. Alcohol and drug use were documented through structured interviews. Risky alcohol use was defined as >20g/day(males) and >10g/day (females). Clinical severity of aSAH was assessed using the World Federation of Neurological Surgeons(WFNS) scale; radiographic severity was classified using the modified Fisher scale. Univariate and multivariate analyses were performed to evaluate associations between substance use, IA rupture, and severity. Results: Risky alcohol consumption was reported in 4.6

PURPOSE:To determine the incidence and characteristics of severe cardiorespiratory events during intra-arterial chemotherapy (IAC) for retinoblastoma and to evaluate a potential association with the COVID-19 pandemic. METHODS:This single-center retrospective observational study included 108 children who underwent 280 IAC procedures between January 2017 and May 2024. Severe cardiorespiratory events were defined by acute oxygen desaturation accompanied by increased peak airway pressure, reduced tidal volume, bradycardia, or hypotension. Patient demographics, procedural details, and periprocedural outcomes were extracted from anesthesia and radiology records. A multivariable generalized linear mixed model with a logit link was used to assess associations with severe cardiorespiratory events while accounting for repeated procedures within patients. RESULTS:Severe cardiorespiratory events occurred in 18 procedures (6.4%) among 15 patients, increasing from 3 procedures (2.2%) before the COVID-19 pandemic to 15 procedures (10.5%) during or after the COVID-19 pandemic (P=0.011). Procedures performed during or after the pandemic were associated with higher odds of severe cardiorespiratory events (OR 7.1, 95% CI 1.6 to 31.8). Most events occurred during the second or subsequent IAC sessions. Management included manual ventilation, increased oxygen delivery, propofol bolus, and deepening of anesthesia. No procedures were interrupted due to severe cardiorespiratory events. CONCLUSION:Severe cardiorespiratory events during IAC were more frequent during and after the COVID-19 pandemic, often presenting as bronchospasm-like events. All events were managed successfully without procedural interruption. Given the retrospective design and the lack of individual SARS-CoV-2 infection data, these findings should be considered hypothesis-generating and require confirmation in larger prospective multicenter studies.

The Contour Neurovascular System (CNS) is an intrasaccular flow-disrupting device for treating intracranial aneurysms. Conventional follow-up imaging of the CNS with MR angiography or conventional CT angiography often suffers from significant artifacts. Photon-counting CT angiography (PCCTA) is a novel technique offering superior spatial resolution and reduced beam-hardening artifacts. We report one of the first cases of a 48-year-old patient with an anterior communicating artery aneurysm treated with a CNS who underwent follow-up imaging with PCCTA. The examination provided markedly artifact-reduced images, enabling clear visualization of the CNS, complete aneurysm occlusion, and adjacent vessel patency. Compared with MR angiography, PCCTA offered substantially improved depiction of the device itself, highlighting its unique value for precise, non-invasive follow-up of intracranial neurovascular implants and its potential as an alternative for detailed post-procedural assessment of the CNS.

BackgroundEndovascular thrombectomy (EVT) for isolated posterior cerebral artery (PCA) occlusion remains incompletely characterized, particularly regarding segment-specific presentation and outcomes. We aimed to compare clinical profiles, procedural results, and early neurological and imaging outcomes between P1 and P2 PCA occlusions treated with EVT.MethodsWe retrospectively analyzed EVT-treated patients with acute ischemic stroke at a tertiary center from 2018–2025 (n = 1,166). Thirty-nine patients with isolated PCA occlusion were included in the final analysis (P1 n = 27; P2 n = 12). Successful reperfusion was defined as mTICI 2b–3. Baseline and 24-h CT were assessed for detecting ischemic change using posterior circulation ASPECTS (PC-ASPECTS). Neurological deficits were analyzed using NIHSS total scores and clinical domain profiles.ResultsPatients with P1 occlusion presented with higher admission stroke severity than those with P2 occlusion [NIHSS 12 (7–23) vs. 7 (4–9)] and more frequent motor/sensory deficits and facial palsy, whereas P2 occlusions commonly presented with visual dysfunction. Successful reperfusion was achieved in 72% overall (P1 78% vs. P2 58%). Median 24-h PC-ASPECTS was similar [8 (IQR 8–9)]. Despite successful reperfusion in P1 occlusion, neurological impairment frequently persisted at discharge, particularly in motor, sensory, vigilance, and language-related domains. Infarct demarcation at 24 h remained frequent, including thalamic involvement in 41% (P1) and 36% (P2). For P1 occlusions, successful reperfusion was associated with less thalamic (29% vs. 83%) and occipital (52% vs. 83%) infarct demarcation. Any intracranial hemorrhage occurred in 13% without segment differences; in-hospital mortality was 26%.ConclusionP1 and P2 segment occlusions showed distinct clinical phenotypes, while EVT was technically feasible with acceptable safety. However, persistent deficits and brain tissue injury were common despite successful reperfusion.

Pediatric patients undergoing head CT are particularly vulnerable to radiation exposure and its potential long-term effects. Dose optimization is especially critical when multiple scans are required, where dose should remain consistently low and stable. This study aims to analyze inter-and intra-individual variation of radiation dose of head CT in pediatric patients. In this retrospective observational single-center study, radiation dose data from 411 head CTs of 123 patients (male 68; female 55) at two different CT devices with similar technical parameters were analyzed. Four age groups (3–12 months, 1–5, 5–10 and 10–15 years) were evaluated. Volume-weighted CT dose index (CTDIvol), dose-length product (DLP) and effective dose (ED) were analyzed and compared inter- and intra-individually. Radiation dose varied substantially between scanners, with median CTDIvol differences of up to 34.7

Purpose:The effect of iodine preparation concentration on vascular attenuation during computed tomography angiography (CTA) is a topic of controversy. Iodine-based contrast media (CM) formulations are used in different iodine preparation concentrations and, accordingly, their viscosity varies considerably. This study aimed to investigate the influence of CM formulations with different iodine preparation concentrations on image quality under conditions of a constant iodine dose and constant iodine delivery rate (IDR) in low-dose, low-kVp thoracoabdominal CTA using a standardized animal model. Materials and Methods:A cohort of six healthy Göttingen minipigs underwent three low-dose CTA scans (90 kV, CTDIvol = 1.7 ± 0.5 mGy) using three CM formulations with different iodine preparation concentrations (300, 370, and 400 mgI/mL). All formulations were injected at a constant IDR of 1.3 gI/s and at a constant total iodine dose of 252 mgI/kg in a randomized sequence. Quantitative image quality was assessed using contrast-to-noise ratio (CNR) and image similarity metrics. Subjective image quality was evaluated by two experienced radiologists using a 5-point Likert scale. Results:No significant differences in CNR were observed between the CM formulations (300 mgI/mL = 15.6 ± 2.8, 370 mgI/mL= 15.0 ± 3.8, 400 mgI/mL = 15.0 ± 4.9). The subjective image quality evaluations revealed no significant differences between the groups, except for a slight tendency towards higher ratings for the 300 mgI/mL formulation for sharpness (300 mgI/mL=5 (4.3-5), 370 mgI/mL = 4 (4-5), 400 mgI/mL = 4 (4-5)) and diagnostic acceptability (300 mgI/mL = 4 (3-4), 370 mgI/mL = 3.5 (3-4), 400 mgI/mL = 3.5 (2.3-4)). Conclusion:Under the investigated conditions of constant iodine delivery rate and constant iodine dose, CM formulations with iodine preparation concentrations ranging from 300 to 400 mgI/mL do not lead to significant differences in objective or subjective image quality in low-dose, low-kVp CTA. These findings represent a proof-of-concept under controlled experimental conditions. Key Points:· A standardized animal model allowed a controlled analysis of CM formulations with different iodine preparation concentrations.. · At a constant IDR and total iodine dose, image quality remained comparable across the investigated CM formulations.. · A higher iodine preparation concentration did not result in a measurable image quality benefit with a fixed IDR.. Citation Format:· Holtkamp M, Jost G, Salhöfer L et al. The Effect of Contrast Media Formulations with Different Iodine Preparation Concentrations at a Constant Iodine Delivery Rate in Low-kV CT Angiography: An Experimental Animal Study. Rofo 2026; DOI 10.1055/a-2818-5244.

Chronic subdural hematoma (cSDH) is a common and growing neurosurgical condition, particularly in the elderly, with high recurrence rates following conventional surgical evacuation. Traditional management strategies primarily address mass effect through drainage but fail to target the underlying pathophysiological mechanisms responsible for hematoma persistence and recurrence. Increasing insights into the role of inflammation, angiogenesis, and fragile neovascular membranes supplied by the middle meningeal artery (MMA) have led to the development of MMA embolization as a targeted therapeutic approach. Over the past decade, MMA embolization has evolved from an experimental salvage technique to an evidence-based intervention. Early observational studies and meta-analyses demonstrated marked reductions in cSDH recurrence and reoperation rates compared with standard surgical management. More recently, large randomized controlled trials have provided consistent, high-level evidence confirming that MMA embolization, particularly as a surgical adjunct, lowers rates of hematoma recurrence, treatment failure, and serious adverse events. Consequently, contemporary consensus guidelines released in 2025 endorse MMA embolization as a class I recommended adjunct therapy for selected patients with nonemergent cSDH. Beyond its adjunctive role, MMA embolization is increasingly being explored as a standalone treatment option. This minimally invasive strategy holds particular promise for frail, elderly patients or those with significant comorbidities who are at high risk for surgical complications. Ongoing trials are aimed at refining patient selection, optimal intervention timing, and embolic techniques. In summary, current evidence supports a paradigm shift in cSDH management toward a pathophysiology-driven, preventive, and increasingly endovascular treatment model. Question Does middle meningeal artery (MMA) embolization represent a paradigm shift in chronic subdural hematoma (cSDH) management? Findings Randomized trials show MMA embolization, as a surgical adjunct, reduces recurrence and treatment failure in cSDH, earning a Class I guideline recommendation. Clinical relevance MMA embolization shifts cSDH management from reactive surgical drainage to a proactive strategy targeting the pathologic neomembranes. This pathophysiology-based approach prevents hematoma recurrence, improving long-term outcomes and establishing a new treatment paradigm.

PURPOSE:Variants of basal vein of Rosenthal (BVR), particularly the primitive drainage pattern, have been associated with the occurrence of perimesencephalic non-aneurysmal subarachnoid hemorrhage (PMNSAH). However, less is known about their impact on the initial hemorrhage burden and the neurological sequela of PMNSAH. METHODS:This retrospective single-center study included 78 consecutive PMNSAH patients from 2002 to 2025 and 78 propensity-score-matched angiographic control patients selected from a pool of 117 controls. Variants of BVR were classified on DSA according to Watanabe classification; the maximum hemispheric type (BVR_max) was subcategorized. Hemorrhage burden at admission was quantified using a perimesencephalic modified Hijdra-based score (PM-mHSS). Neurological impairment of patients was assessed at admission with Glasgow Coma Scale, World Federation of Neurosurgical Societies, Hunt and Hess grading system and at discharge with modified Rankin Scale. RESULTS:BVR drainage patterns differed between PMNSAH and propensity-score-matched controls, most pronounced for BVR_max (p=0.006). Primitive drainage (type 3) was more frequent in PMNSAH than in matched controls (47.4% vs 24.4%). In Bayesian ordinal regression models, variants of BVR did not correlate with severity of neurological impairment at admission, hemorrhage burden, or discharge mRS. Increasing age was independently associated with higher modified Fisher grade (OR 1.06; 95% CI, 1.01-1.10; p=0.02), higher PM-mHSS total (OR 1.06; 95% CI, 1.02-1.11; p=0.004), and worse discharge mRS (OR 1.06; 95% CI, 1.00-1.11; p=0.04). CONCLUSION:Primitive BVR drainage is more frequent in PMNSAH than in propensity-score-matched angiographic controls, supporting a venous contribution to PMNSAH susceptibility. BVR variants have less relevance on initial hemorrhage burden or neurological sequela from admission to discharge.

Deciding on intravenous thrombolysis (IVT) in acute ischemic stroke (AIS) patients with reported recent direct oral anticoagulant (DOAC) intake remains challenging due to concerns about hemorrhagic risk and the absence of randomized controlled trial evidence. This study aimed to provide a comprehensive characterization of all AIS patients with reported recent DOAC intake—regardless of IVT eligibility—treated at a comprehensive stroke center that routinely measures calibrated anti-facor IIa/Xa activity at admission. In this retrospective study, clinical and procedural data from AIS patients with recent DOAC intake and calibrated anti-factor IIa/Xa activity measured within three hours of admission were analyzed. Patients were treated at the University Hospital Essen between March 2017 and October 2023. Among 469 included patients, anti-factor IIa/Xa activity was ≤ 30 ng/ml in 28

BACKGROUND:Quantitative data on the impact of smoking on genesis of intracranial aneurysms (IA) is sparse. We aimed to analyze the association between lifetime and current smoking exposure and IA characteristics. METHODS:In this prospective observational cohort study (07/2016-01/2023, n = 918), all patients or next of kin filled out the questionnaire for assessment of smoking habits including the status (no/former/current) and consumption level (heavy vs light current smoker [≥/<10 cigarettes/day], and lifetime exposure in pack-years). The study endpoints were the ruptured status, size, and presence of multiple IA. RESULTS:The distribution of non-, former, light, and heavy smokers was 23.2 %, 25.6 %, 11.2 % and 40 % respectively. The median lifetime smoking exposure was 20 pack-years. Current smokers were at higher risk of presenting with ruptured (adjusted odds ratio [aOR]=1.71, 95 % confidence interval [CI]=1.29-2.26, p < 0.0001), large (≥7 mm, aOR=1.41, 95 % CI=1.05-1.89, p = 0.022) and multiple IA (aOR=1.34, 95 % CI=1.01-1.77, p = 0.045). In the subgroup analysis among ever smokers, heavy smoking additionally increased the risk of IA rupture (aOR=1.83, 95 % CI=1.33-2.50, p < 0.0001) and larger size (aOR=1.65, 95 % CI=1.19-2.30, p = 0.003). Finally, longer history of smoking (>20 pack-years) was related to higher probability of multiple (aOR=1.61, 95 % CI=1.21-2.13, p = 0.001) and large IA (aOR=1.40, 95 % CI=1.04-1.87, p = 0.025). CONCLUSIONS:Our data underline the role of smoking in IA genesis, and the importance of smoking cessation for rupture prevention. Current and particularly heavy smoking increases the risk of IA rupture, whereas the chronic exposure over years more likely results in the development of multiple and large IA.

BACKGROUND:Uveal melanoma (UM) patients with liver metastases often undergo hepatic artery infusion therapy (HAIC). Due to diffuse metastatic spread in the liver, patients often develop hepatomegaly and secondary, portal hypertension which may lead to splenomegaly. This study aimed to compare spleen volumetry and the change of spleen volume (SV) for the evaluation of HAIC treatment response. PATIENTS AND METHODS:In this study, 179 UM patients (mean age 64.8 ± 11.0y, 53% female) with liver metastases undergoing HAIC were included. Treatment response was analyzed by RECIST 1.1 and SV on CT imaging before and after first HAIC. The correlation of change in spleen and liver volume was analyzed with Spearman test. Overall survival (OS) was calculated as the time from the first HAIC to patient death using Kaplan-Meier test and multivariate analysis was performed for RECIST 1.1 and SV. RESULTS:In the study population, OS was 13.8 months (95% CI 10.6-14.7 months). Change in SV before and after first HAIC was +4% (interquartile range [IQR] -4.0%-12.0%, p = 0.49) and showed a weak correlation with OS (r = -0.11, p = 0.18). UM patients with progressive disease (PD) according to RECIST 1.1 showed an increase in SV compared to patients with stable disease (SD) (p = 0.04). Compared to RECIST 1.1, SV was not significant prognostic factor that can identify a change in OS. CONCLUSIONS:In uveal melanoma patients with liver metastases undergoing HAIC, neither the change of SV nor splenomegaly could be identified as prognostic factors for OS.

Background and ObjectivesFamilial cavernous malformations (FCMs) are vascular lesions that pose a lifelong risk of symptomatic hemorrhage (SH) and seizures, yet their natural history remains unclear. This study aims to determine the cumulative lifetime risk of a first SH and/or seizure and assess whether genetic variations influence these risks.MethodsThis international, multicenter retrospective cohort study included data from 16 tertiary referral centers and 1 patient advocacy group. Eligible patients had confirmed or suspected FCM, available magnetic resonance imaging (MRI) data, documented baseline clinical features, and longitudinal follow-up (FU). Functional outcomes were assessed using the modified Rankin Scale (mRS) at last FU. Direct adjusted survival curves and mixed-effects Cox regression analyses were performed to estimate cumulative lifetime risk. The association between genetic variations and SH/seizure rates was evaluated, and mixed-effects logistic regression assessed the effect of SH/seizures on mRS outcomes.ResultsA total of 1,592 patients with FCM were included, with a mean age of 37.6 years (SD 17.1) and 55.7% female. The median FU was 42 years (IQR: 27-55), totaling 64,146 person-years. Of these, 869 (54.6%) had confirmed FCM, 775 (48.7%) experienced at least 1 hemorrhage, and 447 (28.1%) had at least 1 seizure. Genetic testing was performed in 47.7%, identifying CCM1 (31.0%), CCM2 (4.8%), and CCM3 (1.9%) variations. The lifetime risk of a first SH was similar to 80%, with an event rate that remained constant beyond age 20. The lifetime risk of a first seizure was similar to 45%. Patients with CCM3 variations exhibited a more aggressive hemorrhagic course than those with CCM1 (hazard ratio 1.799, 95% CI 1.008-3.208). SH and seizures were independently associated with worse mRS outcomes at last FU.DiscussionThe event rate of SH and seizures remained stable over time, leading to high cumulative lifetime risks. Patients with CCM3 variations exhibited a more aggressive disease course. Limitations include the non-population-based design, selection bias from tertiary centers, retrospective data collection, and variability in data extraction across centers. However, this study represents the largest international FCM cohort to date, improving the precision of risk estimates and providing valuable insights into disease progression.

In case of multiple (unruptured) intracranial aneurysms (M[U]IA), deciding which intracranial aneurysms (IA) should be treated and which at first can be challenging. The most accepted risk factor in making these decisions is IA size. However, a smaller intracranial counterpart aneurysm (SICA) and not the largest IA in patients with MIA might cause subarachnoid hemorrhage (aSAH). By falsely assessing a SICA as benign and withholding treatment, these patients are put at risk for SICA rupture before treatment. Therefore, there is a paramount need to improve the identification of more rupture-prone SICA, especially regarding the improved accessibility to intracranial imaging leading to increasing incidences of patients with (M)IA. From our institutional observational cohort, containing data of all patients with IA treated between 01/2003 and 06/2016, 285 patients with MIA who were hospitalized for acute aSAH were identified. In 261 patients, the largest of their IA ruptured, and in 24 patients, a SICA ruptured (defined by a size difference of ≥ 2 mm). Different demographic, clinical, laboratory, and radiographic characteristics of patients and IA were collected. Univariate and multivariate binary regression analyses (UVA, MVA) were performed to identify putative risk factors for the rupture of SICA. In the final MVA, the total number of IA (p = 0.043; aOR = 1.61) and the intake of multiple antihypertensive drugs (p < 0.001; aOR = 3.96) showed a statistically significant association with the ruptured status of SICA. In contrast, smoking (p = 0.825), radiographic risk factors (i.e., daughter sack p = 0.736, IA irregularities p = 0.286, location p = 0.665), arterial hypertension (p = 0.869), and blood examinations did not show a statistically significant regression with the rupture of SICA. This study found statistically significant putative risk factors to identify IA rupture factors that might overweight IA size in certain situations. Thereby, a subgroup of MIA patients could be identified who require treatment with ≥ 2 antihypertensive agents or have a high number of IA that might benefit from a simultaneous treatment of more than one UIA in a single session. Further studies are needed to verify these results and improve the identification of more rupture-prone SICA in MUIA patients.

BACKGROUND AND OBJECTIVES:Brainstem cavernous malformations (BSCM) can result in spontaneous intracerebral hemorrhage (ICH), often resulting in significant morbidity. We aimed to assess the functional outcome and identify predictors of functional neurological outcome after single and multiple symptomatic hemorrhages. METHODS:As part of an international multicenter collaboration, institutional databases from 3 different tertiary referral centers included BSCM patients with complete baseline characteristics, MRI Data set, ≥1 ICH, and ≥1 follow-up examination followed at our institutions between 2003 and 2023. Functional neurological outcome was obtained using the modified Rankin Scale at diagnosis, before and after each ICH, and last follow-up. Patients were excluded after surgical removal of the lesion and/or loss of follow-up. RESULTS:A total of 383 patients (41.47 ± 15.51 age; 220 [57.4%] female) were included and followed for an average of 63.16 ± 85.75 months. Functional neurological outcome deteriorated in 47.2% ( P = .010) after the second ICH and in 46.5% ( P = .007) after the third ICH. Moreover, the functional neurological status was impaired in 22.3% ( P < .001) of patients at last available follow-up compared with the time of BSCM diagnosis. CONCLUSION:In our study, we observed that the chance of full recovery might decrease with each ICH. We observed a significantly associated neurological deterioration after each ICH compared with initial ICH.

Image-guided bone biopsies have become indispensable in the diagnosis of a wide range of diseases, from incidental suspicious lesions to the evaluation of treatment response and the staging of malignancies. The aim of this evaluation of the prospectively managed voluntary multinational registry of the German Society for Interventional Radiology and Minimally Invasive Therapy (DeGIR) was to analyze the use, technical success, and complications of image-guided diagnostic biopsies of bone lesions. All bone biopsies reported in the DeGIR registry between 2018 and 2022 were included. Technical success was defined as the successful image-guided placement of the sampling device within the bone lesion. Technical success and complication rates were compared across various parameters by Fisher’s exact and chi-square test. p<0.05 was considered statistically significant. A total of 17397 diagnostic punctures (female: 52% (9046/17397), outpatient procedures: 34% (5924/17397), median age: 64y (IQR 51–75y)) from 214 centers in Germany, Austria, and Switzerland were analyzed. The technical success rate was 98.9% (17201/17397), with histological representativeness in 93.2% of cases (10316/11071). Outpatient procedures had a higher technical success rate (99.3%, 5884/5924) compared to inpatient procedures (98.6%, 11316/11473, p<0.0001), but lower histological representativeness (91.1%, 1284/1410 vs. 93.5%, 9031/9661, p=0.001). The overall complication rate was 0.62% (108/17397), with major complications being predominantly parenchymal bleeding. Solid or subsolid lesions had higher histological representativeness (94.0%, 7846/8346) compared to necrotic-cystic lesions (90.3%, 1558/1725, p<0.0001). Image-guided bone biopsies are highly effective and safe. The high technical success rates and low complication rates underscore their clinical utility. The DeGIR registry provides valuable insight into the performance and outcomes of these procedures, highlighting their importance in interventional radiology.