A quantification technique for costal cartilage calcification using ¹⁸F-sodium fluoride–positron emission tomography/computed tomography (¹⁸F-NaF-PET/CT) has yet to be established, and the effects of aging and other demographic variables on costal cartilage calcification remain understudied. This study aims to introduce a quantification methodology for assessing costal cartilage calcification using ¹⁸F-NaF-PET/CT, assess age-related changes in its ¹⁸F-NaF uptake in females and males, and examine the relationship between its ¹⁸F-NaF uptake and CT attenuation as well as ¹⁸F-NaF uptake and coronary artery calcification. In this retrospective study, we analyzed subjects from the Cardiovascular Molecular Calcification Assessed by ¹⁸F-NaF PET/CT (CAMONA) clinical trial. This study evaluated 130 subjects (mean age 48.7 ± 14.5 years; n = 67 females). We manually generated regions of interest overlying the costal cartilages from ribs 8 to 10 on the left side, carefully avoiding osseous uptake from adjacent ribs and sternum, to measure cartilaginous ¹⁸F-NaF uptake. Non-parametric statistical analyses (Spearman correlations, Mann–Whitney U tests, Kruskal–Wallis tests) and receiver operating characteristic analysis were performed to evaluate sex-specific age-related changes in uptake, correlations between imaging parameters, and associations with coronary artery calcium (CAC) score. In females, the mean ¹⁸F-NaF uptake (as assessed by average SUV_mean) was 0.69 ± 0.38 while the corresponding mean Hounsfield Unit (HU) was 108.0 ± 40.0. In males, the mean ¹⁸F-NaF uptake (as assessed by average SUV_mean) was 0.63 ± 0.22, and the mean HU was 104.0 ± 24.0. There was a significant correlation between ¹⁸F-NaF uptake and age in both females (p = 0.003, r = 0.36) and males (p < 0.0001, r = 0.63). The correlation was significantly stronger in males than females (Fisher’s z-test, p = 0.040). There was a significant correlation between CAC score and costal cartilage SUV_mean in both females (r = 0.26, p = 0.036) and males (r = 0.51, p < 0.0001). This study introduces a quantification technique to assess costal cartilage calcification using ¹⁸F-NaF-PET/CT and demonstrates that the calcification increases with age, more strongly in males than in females, and ¹⁸F-NaF uptake is correlated with CAC score. This technique can be applied to other cartilages of interest, in both physiological and pathological conditions, to assess the effects of aging and various demographic variables on cartilage calcification.

Background: The Surpass Elite (Stryker Neurovascular) is a third-generation flow diverter featuring modified braid architecture with increased braid angle and novel surface charge neutralization treatment. This study presents the first clinical experience with the Surpass Elite globally. Methods: A retrospective analysis of 81 consecutive cases (78 unique patients) treated with the Surpass Elite across four centers by two operators from January to July 2025 was performed. Data collected included patient demographics, aneurysm characteristics, procedural details, technical success, complications, and angiographic/clinical outcomes. Primary endpoints were technical success rate, perioperative safety profile, and aneurysm occlusion rates at approximately 6-month follow-up. Results: The cohort comprised 78 unique patients (76.9% female, mean age 59.2 ± 14.5 years) with 81 aneurysms treated using 112 total devices (mean 1.38 devices per case). Aneurysms were predominantly located in the internal carotid artery (75.3%). Technical success was achieved in 100% of cases regardless of access site. Balloon angioplasty was required in only 13.6% of cases. Among 61 aneurysms with complete angiographic follow-up at a mean of 6 months, complete occlusion (RROC Class I or OKM Grade D) was achieved in 78.7%. In-stent stenosis (< 50%) was observed in only 3.3% of cases with follow-up imaging, suggesting favorable vessel remodeling with minimal intimal hyperplasia. The immediate intraprocedural complication rate was 2.5% (2/81), including one device-related microperforation (complete recovery) and one intraoperative thrombosis (managed successfully intraprocedurally; delayed stroke from subsequent medication noncompliance). Delayed complications within 30 days included one stroke from antiplatelet noncompliance (fatal) and one access-site hematoma (recovered). One delayed adverse event beyond 30 days (delayed right temporal intraparenchymal hemorrhage at 10 months) was observed in a patient on dual antiplatelet therapy plus apixaban and was attributed to cerebral amyloid angiopathy; this event was not considered device- or procedure-related. Overall mortality was 7.4% (6/81): one death (1.2%) was procedure-related (stroke from medication noncompliance), one death occurred within 30 days from post-SAH vasospasm in a ruptured aneurysm case, and four deaths occurred after 30 days (recurrent ICH at 3 weeks, acute respiratory failure with acute on chronic heart failure at 5 months, homicide at approximately 6 months, and one of unknown cause), none of which were device- or procedure-related. Conclusion: This first published clinical experience with Surpass Elite flow diverter demonstrates reliable technical deliverability, favorable early occlusion rates comparable to established flow diverters, and a satisfactory safety profile. The low rates of required balloon angioplasty support the clinical benefit of the modified braid architecture. These preliminary findings support the continued clinical evaluation of the Surpass Elite in larger prospective cohorts.

Purpose: Steerable guidewires with deflectable tips enable real-time navigation through complex cerebrovascular anatomy without requiring wire removal and tip reshaping. Despite promising early reports, systematic clinical evaluation remains limited. Methods: We conducted a retrospective analysis of 58 consecutive neurointerventional procedures utilizing steerable guidewires at two centers from September 2024 to August 2025. The cohort comprised 48 cases using the Drivewire 24 (DW24, 0.024-inch diameter) and 10 cases using the Artiria SmartGUIDE (0.014-inch diameter). Primary outcomes included technical success, safety profile, and operator assessment. We also performed a scoping literature review of all published steerable guidewire studies in neurointerventional applications. Results: Technical success in reaching target vessels was achieved in 100% of cases for both systems with no intraoperative or postoperative complications. Mean fluoroscopy time was 32.7 ± 29.5 min for DW24 and 26.1 ± 16.2 min for Artiria procedures. Treatment indications included aneurysm procedures (53.4%), diagnostic angiographies (20.7%), venous sinus stenting (13.8%), middle meningeal artery embolizations (8.6%), and stroke interventions (3.4%). 8.3% of procedures using DW24 were considered higher-risk by the primary operator without steerable capability, including successful navigation of complex posterior circulation anatomy in giant basilar aneurysms and recurrent superior cerebellar artery aneurysms with prior stent constructs. Our limited experience with the Artiria system ( n = 10) revealed operator-noted challenges with shape retention. The scoping review identified only three prior studies encompassing 65 procedures, establishing this as the largest reported experience. Conclusion: Both steerable guidewire systems achieved perfect technical success with excellent safety profiles. Based on our preliminary experience, the DW24 appeared to offer advantages for procedures requiring navigating larger catheters through tortuous anatomy. These findings support selective clinical use of steerable guidewire technology in challenging neurointerventional procedures.

Purpose ¹⁸F-fluorodeoxyglucose (FDG) Positron Emission Tomography (PET)/Computerized Tomography (CT) is an important imaging modality in oncology, but its use in spinal cord assessment is limited due to a lack of baseline metabolic reference values. Regional spinal cord FDG uptake, especially in healthy populations, remains poorly defined, limiting accurate delineation between physiological and pathological uptake. The study aimed to quantify regional FDG uptake in the cervical, thoracic, and lumbar spinal cord in healthy adults, and evaluate associations between FDG uptake and demographic factors, including age, sex, body mass index (BMI), and inflammatory/metabolic biomarkers. A secondary aim was to apply artificial intelligence (AI)-driven segmentation to facilitate standardized region-of-interest extraction across spinal cord levels. Methods This was a retrospective, cross-sectional observational study conducted using data from the CAMONA clinical trial at Odense University Hospital, Denmark. 76 healthy adult participants (mean age 44.66 ± 14.04 years; 53.9% male) were selected from a total of 139 subjects in the CAMONA trial. All participants were free from chronic medical conditions. Primary outcomes include mean standardized uptake values (SUVmean) of FDG in the cervical, thoracic, and lumbar spinal cord regions. Secondary outcomes include correlations of SUVmean with age, sex, BMI, HbA1c, and inflammatory biomarkers (CRP, WBC, homocysteine, fibrinogen). Participants underwent FDG PET/CT imaging 180 min post-injection of 4.0 MBq/kg FDG. Using TotalSegmentator, an AI-driven segmentation tool, the spinal cord was delineated into cervical, thoracic, and lumbar volumes of interest (VOIs). Regional SUVmeans were calculated and analyzed. Statistical tests included one-way ANOVA with Tukey’s post-hoc, Spearman/Pearson correlations and t-tests to assess associations with age, sex, BMI, and inflammatory/metabolic biomarkers. Results FDG uptake was highest in the cervical spinal cord (SUVbw 1.36 ± 0.23), followed by the lumbar (0.85 ± 0.18) and thoracic (0.76 ± 0.17) regions (p < 0.001); this regional ordering was preserved after lean-body-mass-normalized SUV (SUL) recomputation. No significant associations were found with age or sex. BMI correlated positively with SUVbw across all regions (ρ = 0.34–0.47, all p ≤ 0.003); under SUL, the cervical and thoracic associations attenuated to non-significance (cervical ρ = +0.13, p = 0.255; thoracic ρ = +0.17, p = 0.151), whereas a residual lumbar association persisted (ρ = +0.32, 95% CI + 0.09 to + 0.52, p = 0.004). A nominal association between HbA1c and cervical uptake (ρ = 0.24, p = 0.040) did not survive Bonferroni correction for multiple comparisons (α = 0.0033) and is reported as exploratory. Inflammatory markers showed no significant correlation in any spinal cord region. Conclusion FDG PET/CT reveals consistent regional variation in spinal cord metabolic activity, with highest uptake in the cervical region. Normative uptake was stable across age and sex but showed a positive association with BMI when SUV was normalized to total body weight that was largely abolished after lean-body-mass normalization (SUL) in the cervical and thoracic regions but persisted in the lumbar region (lumbar SUL ρ = +0.32, 95% CI + 0.09 to + 0.52, p = 0.004). These findings offer foundational data for clinical interpretation and differentiation between physiology and pathology of spinal FDG PET/CT uptake and demonstrate the feasibility of AI-driven segmentation for standardized region-of-interest extraction in spinal imaging analysis.

Purpose: The venous phase of DSA offers inferior spatial resolution of cerebral venous anatomy due to contrast dilution. Likewise, retrograde cerebral venography (RCV) suffers from poor contrast retention due to contrast injection opposing the physiological direction of venous drainage. Therefore, this study aims to investigate the feasibility of balloon-assisted occlusion in improving visualization of cerebral venous anatomy during RCV. Methods: 17 consecutive patients who underwent balloon-assisted RCV between September 2023-June 2025 were included. A 9 F balloon guide catheter was positioned in the internal jugular vein or sigmoid sinus. Venography was performed before and after balloon inflation. Using standardized criteria, three neuroradiologists independently assessed visualization quality of venous structures, anatomical furthest extent of contrast enhancement, and pathology delineation. McNemar’s test was used for paired statistical comparisons between visualization with and without balloon occlusion. Results: Balloon inflation improved rates of “well visualized” pathology from 15.7% to 88.2% ( p < 0.001, OR = 29.04). The most distant structure visualized shifted from the ipsilateral sigmoid sinus without balloon occlusion (visible in 45.1% of cases) to the contralateral sigmoid sinus with balloon occlusion (visible in 72.5% of cases, p < 0.001). With balloon occlusion, homogenous opacification and clear margin delineation of both transverse and sigmoid sinuses showed significant improvements ( p < 0.001 for both). No procedure-related complications were observed in this limited cohort. Conclusion: In this feasibility experience, balloon-assisted occlusion during RCV improved visualization of the posterior and lateral dural venous sinuses and associated pathology. Future well-powered studies are needed to validate our findings and determine the definitive safety of this technique.

Objective: Thyroid cartilage calcification and glucose metabolism may vary with age and gender. This study aimed to investigate the role of [18F]-sodium fluoride ([18F]NaF) and 2-[18F]fluoro-2-deoxy-D-glucose ([18F]FDG) PET/CT for the evaluation of physiological molecular calcification and glucose metabolism of thyroid cartilage with age. Methods: This retrospective study analyzed [18F]NaF and [¹⁸F]FDG PET/CT images from the CAMONA study (NCT01724749). Regions of interest were placed around the thyroid cartilage on CT images using OsiriX software. The mean standardized uptake value (SUVmean) was measured for [¹⁸F]NaF and [¹⁸F]FDG PET/CT images. Pearson correlation coefficients were calculated to evaluate the effects of aging on the uptake of [¹⁸F]NaF and ^[18F]FDG in the thyroid cartilage. Results: A total of 127 healthy subjects (65 females and 62 males) with a mean age of 48.46±14.13 (range 21–75) years for [¹⁸F]NaF PET/CT and a total of 114 healthy subjects (52 females and 63 males) with a mean age of 49.05±14.29 (range 21–75) years for [¹⁸F]FDG PET/CT were included. A significant positive correlation was observed between age and SUVmean of [¹⁸F]NaF in the thyroid cartilage (r=0.18, p=0.04). This result indicates that molecular calcification of this cartilage increases with aging. However, the correlation between age and SUVmean of [¹⁸F]FDG in the thyroid cartilage was not statistically significant (r=-0.09 p=0.31). Conclusion: This study presents a novel methodology for the determination of molecular calcification and glucose metabolism of laryngeal cartilage using [¹⁸F]NaF and [¹⁸F]FDG PET/CT. Molecular calcification of thyroid cartilage was found to increase with age, whereas glucose metabolism did not show a statistically significant correlation with age.