Purpose: It is currently unclear how useful repeat computed tomography angiography (CTA) is in spontaneous subarachnoid haemorrhage (SAH) patients after negative initial digital subtraction angiography (DSA). The purpose of this study is to assess the yield of repeat CTA for the detection of...

Purpose: We reported the clinical and radiological outcome of an aggressive dural arteriovenous fistula (DAVF) after combined glue embolization and hypofractionated helical TomoTherapy (Hypo-HT).Materials and methods: Eleven patients whose radiological examinations are consistent with aggressive DAVF were treated with combined glue embolization and Hypo-HT 30–36 Gy in 5–6 fractions. The dosimetric analysis, clinical response and radiological imaging obliteration rate by magnetic resonance angiography or computed tomography angiography were investigated.Results: There were eight males and three females with a male and female ratio of 2·67. The mean age was 51·2 years old (range 37–69). Anatomical imaging sites of disease included transverse-sigmoid sinuses (n = 7), superior sagittal sinus (n = 3) and tentorium cerebelli (n = 1). The mean pitch and MF of treatment plans were 0·273 ± 0·032 and 1·70 ± 0·31, respectively. The average size of PTV were 15·39 ± 7·74 cc whereas the R_eff,PTV was 1·50 ± 0·25 cm. The average Dmax and Dmin were 37·52 ± 3·34 and 31·77 ± 2·64 Gy, respectively. HI, CI and CI₅₀ were 0·16 ± 0·06, 1·80 ± 0·56 and 7·85 ± 4·16, respectively. The R_eff,Rx and R_eff,50%Rx were 1·80 ± 0·24 and 2·90 ± 0·45 cm, respectively. The R_eff between 50%Rx and 100%Rx was 1·10 ± 0·28 cm on average. With a mean follow up of 28·5 months (range 9–48), the complete recovery of symptoms was found in 72·7 % (eight patients) within 2–12 months after completion Hypo-HT. Partial recovery was reported in 18·2% (two patients). No clinical response was found in 9·1% (one patient). The total radiographic obliteration rate was 27·3% (three patients), subtotal obliteration was 27·3% (three patients) and partial obliteration was 45·4% (five patients).Conclusions: Satisfactory clinical response of aggressive DAVF was found in all treated patients by combining glue embolization and Hypo-HT. All dosimetric parameters were acceptable. We still need an extended follow up time to assess further radiographic obliteration rate and late side effects of the treatment.

Background/Objectives: This study aims to identify baseline imaging parameters, across various imaging modalities, that can predict the response to bleomycin sclerotherapy in patients with head and neck lymphatic–venous malformations (LVMs). Methods: A retrospective analysis of 80 patients (85 lesions) treated at a tertiary care center between January 2018 and December 2022 was conducted. Imaging modalities, including CT, MRI, ultrasonography, and dynamic digital radiographic images, were reviewed for lesion characteristics. Factors including lesion type, volume, morphology, location, and contrast opacification patterns were analyzed for their association with treatment response, defined as a >50% reduction in lesion size and symptom improvement. Univariable and multivariable logistic regression analyses were performed. Results: Of 85 lesions, 45 (52.9%) responded to treatment. Univariable analysis showed that pure lymphatic malformations (OR = 6.12, p = 0.004), macrocystic components (OR = 10, p = 0.016), cavitary morphology on dynamic digital radiographic images (OR = 8.90, p < 0.001), neck location (OR = 4, p = 0.03), and deep-seated lesions (OR = 3.69, p = 0.03) were significantly associated with better outcomes. Multivariable analysis identified cavitary morphology as the strongest predictor (p = 0.04). A combination of cavitary morphology, macrocystic components, and pure LM type yielded the highest predictive accuracy (AUC = 0.80, p = 0.03). Conclusions: The presence of lymphatic channels or large cystic venous spaces—such as macrocystic features on imaging or cavitary morphology—along with neck or deep-seated lesion location, predicts a favorable response to bleomycin sclerotherapy in head and neck LVMs.

Background: Early identification of the etiology of spontaneous intracerebral hemorrhage (ICH) could significantly contribute to planning a suitable treatment strategy. A notable radiomics-based artificial intelligence (AI) model for classifying causes of spontaneous ICH from brain computed tomography scans has been previously proposed. Objective: This study aimed to externally validate and assess the utility of this AI model. Methods: This study used 69 computed tomography scans from a separate cohort to evaluate the AI model’s performance in classifying nontraumatic ICHs into primary, tumorous, and vascular malformation related. We also assessed the accuracy, sensitivity, specificity, and positive predictive value of clinicians, radiologists, and trainees in identifying the ICH causes before and after using the model’s assistance. The performances were statistically analyzed by specialty and expertise levels. Results: The AI model achieved an overall accuracy of 0.65 in classifying the 3 causes of ICH. The model’s assistance improved overall diagnostic performance, narrowing the gap between nonradiology and radiology groups, as well as between trainees and experts. The accuracy increased from 0.68 to 0.72, from 0.72 to 0.76, from 0.69 to 0.74, and from 0.72 to 0.75 for nonradiologists, radiologists, trainees, and specialists, respectively. With the model’s support, radiology professionals demonstrated the highest accuracy, highlighting the model’s potential to enhance diagnostic consistency across different levels. Conclusions: When applied to an external dataset, the accuracy of the AI model in categorizing spontaneous ICHs based on radiomics decreased. However, using the model as an assistant substantially improved the performance of all reader groups, including trainees and radiology and nonradiology specialists.

OBJECTIVE Prophylactic cranial irradiation (PCI) is a standard treatment for small cell lung cancer (SCLC). Reduced radiation doses at the hippocampal region during PCI might protect against neurocognitive decline after radiotherapy (RT). The purpose of this study is to report the outcome of hippocampal avoidance PCI (HA-PCI) in our center. METHODS After the initial treatment of SCLC, patients whose radiographic data confirmed the absence of intracranial metastasis and controlled of the primary disease received HA-PCI. Thai Mental State Examination (TMSE) and bilateral hippocampal volumes were recorded and analyzed using the Wilcoxon Singed Rank test to compare baseline and two time points (3 and 6 months). The two-year overall survival (OS) and brain control rates were estimated using the Kaplan Meier method. RESULTS Between 2018 and 2021, a total of 10 patients were included in the analysis. The median TMSE and bilateral hippocampal volumes showed no statistically significant difference between baseline and 3 and 6 months. Two-year OS and brain control rates were 78.8% and 71.4%, respectively. Three patients developed intracranial relapses after HA-PCI which were located outside the hippocampal region. CONCLUSIONS HA-PCI did not increase intracranial relapse in this study. HA-PCI should be considered as a treatment option which can potentially protect neurocognitive functions.