Search

Arteriovenous malformation (AVM) is a congenital pathology of the development of brain vessels in which the arterial and venous blood beds are directly connected by tangled degenerate vessels. This dangerous disease affects the brain functioning and increasing the risk of intracranial hemorrhage. A method of treating the AVM is embolization, which is the surgery of endovascular filling of AVM vessels by a special embolic agent to block blood flow through them. This method is widely used; however, it sometimes is accompanied by intraoperative rupture of AVM vessels. A combined model of the embolization process is proposed that, in addition to the flow of blood and embolic agent in the AVM, takes into account the overflow of blood into surrounding healthy vessels. For modeling the joint flow of blood and embolic composition within the AVM, a one-dimensional model of two-phase filtering is used. This model is built on the basis of clinical data of real patients obtained during neurosurgeries in the Meshalkin National Medical Research Center. Mathematically, this leads to a special initial boundary value problem for an integro-differential equation with a nonconvex flow. For numerical computations, a monotone modification of the CABARET scheme is constructed that highly accurately localizes the strong and weak discontinuities in the solution to the problem. The main purpose of this paper is to find the optimal scenario of the AVM embolization with respect to safety and efficiency. The objective functional and the constraints occurring in the resulting optimal control problem are chosen according to medical grounds. In the future, it is planned to use the optimal solutions obtained in this paper to improve the surgery technique and increase the safety of neurosurgical operations.

Purpose Translocator protein 18-kDa (TSPO) imaging with positron emission tomography (PET) is widely used in research studies of brain diseases that have a neuro-immune component. Quantification of TSPO PET images, however, is associated with several challenges, such as the lack of a reference region, a genetic polymorphism affecting the affinity of the ligand for TSPO, and a strong TSPO signal in the endothelium of the brain vessels. These challenges have created an ongoing debate in the field about which type of quantification is most useful and whether there is an appropriate simplified model. Methods This review focuses on the quantification of TSPO radioligands in the human brain. The various methods of quantification are summarized, including the gold standard of compartmental modeling with metabolite-corrected input function as well as various alternative models and non-invasive approaches. Their advantages and drawbacks are critically assessed. Results and conclusions Researchers employing quantification methods for TSPO should understand the advantages and limitations associated with each method. Suggestions are given to help researchers choose between these viable alternative methods.

Visualization of cerebrovascular networks is crucial for understanding the pathogenesis of many neurological diseases. Recently developed optical clearing techniques offer opportunities in deep tissue imaging, and have been successfully applied in many research studies. The development of nanotechnology enables the labeling of brain vessels with functionalized micro/nanoparticles embedded with fluorescent dyes. We herein report an efficient method, named LIMPID (Labeled and Interlinked Micro/nanoparticles for Imaging and Delipidation), specific for the precise fluorescence imaging of vascular networks in clearing-treated tissues. This robust vessel labeling technique replaces conventional fluorescence dyes with functionalized polymer micro/nanoparticles that are able to cross-link with polyacrylamide to form dense hydrogels in vessels. LIMPID shows high-robustness during the clearing process without sacrificing fluorescence signals and clearing performance. LIMPID enables three dimension (3D) visualization of elaborate vascular networks in mouse brains and is compatible with other fluorescence-labeling techniques. We have successfully applied this method to acquire cortical vasculature images simultaneously with the neurons or microglia, as well as to evaluate vascular damage in a mouse model of stroke. The LIMPID method provides a novel tool for the precise analysis of vascular dysfunction and vascular diseases.

The article published by Suthiphosuwan et al[1][1] in the September 2020 edition of AJNR made a strong impression on us. The authors elaborate on the clinical, histopathologic, and imaging findings of biopsy-proved cases of primary central nervous system vasculitis (PCNSV). One of the major

Examination, monitoring and analysis of structural changes in the blood vessels of the brain enable the observation of brain functions. Therefore, the segmentation of the entire cerebral vascular network (including the capillaries) is of great importance in terms of the relevant specialist’s opinion on the diagnosis and treatment of a disease. When performed manuall, segmentation of the vascular network of the brain is a long time-consuming and fault-tolerant process. The automatic segmentation of the brain microvascular structure with machine learning approaches eliminates the need for specialists, and provides a method for perfroming cerebral vessel segmentation in a short time. This study provides the empirical comparision of three different deep neural network models including autoencoder, U-Net and ResNet+U-Net for the vascular network segmentation of brain vessels. The experiments are conducted on vesseINN dataset, which is a volumetric cerebrovascular system dataset obtained by two-photon microscopy. The models are evaluated based on accuracy, f1-score, recall, and precision metrics. During the training phase, U-Net and ResNet+Unet achieve 98% accuracy. Auto-encoder, on the other hand, yields 95% accuracy. In the test phase, it is observed that U-Net and ResNet+U-Net models give better results than the autoencoder model, according to the results obtained with 97% accuracy for U-Net and ResNet+Unet networks and 95% accuracy for autoencoder.

Background Stroke is a neurological emergency that tends to be the first cause of death in many countries. Atmospheric variables are strongly associated with stroke, in which subarachnoid hemorrhage (SAH) has been associated in many studies to meteorological risk factors such as air pollution, air pressure, weather changes, and ambient temperature. These characteristics may influence the brain circulation and cause SAH, being diagnosed as idiopathic SAH or SAH with unknown cause. Objective The main objective of this review is to present the most relevant meteorological risk factors that may develop subarachnoid hemorrhage according to the current evidence that supports the strong association. Conclusion Brain vessel circulation may be influenced by atmospheric variables such as air pollution and weather changes, generating intrinsic changes in the intima of the vessels which leads to vasospasm and with comorbidities associated may develop SAH.

Nowadays, nanoparticles (NPs) are considered to be ideal tools for bioimaging and drug delivery. Although increasing research has focused on NP biodistribution, transportation in the interstitial architecture has been neglected. The entire body is connected by the interstitial architecture, which can provide a long-range and direct pathway for NP biodistribution in a nonvascular system. In this study, we report that 10-nm gold NPs injected directly into the interstitial architecture of the tarsal tunnel of rats (intervaginal space injection (ISI)) were delivered to the brain without crossing the blood-brain barrier. Furthermore, NaGdF4 nanoparticles were used to explore the transportation route by magnetic resonance imaging. The results demonstrated that, after ISI, the NaGdF4 nanoparticles were transported through the perivascular interstitial space of the carotid arteries and brain vessels to the brain. This is a special nonvascular transportation route like a stream based on the interstitial architecture that provides an alternative pathway for NP biodistribution.

Актуальность. Исследование сосудов головного мозга у пациентов с неалкогольной жировой болезнью печени (НАЖБП) может раскрыть новые аспекты раннего выявления нарушений церебральной гемодинамики, а также обнаружить группу больных высокого риска. Цель исследования: изучить особенности изменений в сосудах головного мозга у пациентов с НАЖБП в сочетании с инсулинорезистентностью (ИР) или сахарным диабетом (СД) 2 типа. Материалы и методы. Обследовано 74 пациента с НАЖБП (34 больных с неалкогольным жировым гепатозом (НАЖГ) и 40 больных с неалкогольным стеатогепатитом (НАСГ)). Группа сравнения включала 38 пациентов (16 больных с ИP и 22 пациента с СД 2 типа). Состояние кровотока в cосудах головного мозга изучали с помощью ультразвукового дуплексного сканирования экстракраниального отдела общей сонной артерии (ОСА), наружной сонной артерии (НСА), экстракраниального отдела внутренней сонной артерии, средней мозговой артерии, вертебральной артерии (ВА), глазной артерии. Определяли пиковую систолическую скорость (ПСС) и среднюю по времени максимальную скорость кровотока (ТАМХ) в исследуемых сосудах. Результаты. Обращает на себя внимание асимметричное поражение сосудов головного мозга с более выраженным дефицитом кровотока слева при НАЖБП, что более выражено у больных со стадией НАСГ, особенно в сочетании с ИP. Гемодинамически наиболее значимые изменения установлены в ОСА, а именно выявлено снижение ПСС до (38,1 ± 2,3) см/с справа и до (36,6 ± 3,4) см/с слева, снижение ТАМХ — до (20,4 ± 2,1) см/с справа и до (16,7 ± 1,8) см/с слева. Выводы. У пациентов с НАЖБП, ИP и СД 2 типа выявлено снижение скоростных показателей кровотока по экстракраниальным сосудам головного мозга, преимущественно по ОСА, НСА и ВА (сегмент 3). Наиболее выраженный дефицит кровотока установлен у больных НАСГ в сочетании с ИP, преимущественно слева, особенно по ОСА., Background. The studies of brain vessels in patients with non-alcoholic fatty liver disease (NAFLD) can reveal new aspects of early detection of cerebral hemodynamic disorders, and will also allow the identification of a high-risk patients group. The purpose was to investigate the peculiarities of changes in the brain vessels in patients with NAFLD in combination with insulin resistance (IR) or type 2 diabetes mellitus (T2DM). Materials and methods. The study involved 74 patients with NAFLD (34 patients with non-alcoholic fatty hepatosis (NAFH) and 40 patients with non-alcoholic steatohepatitis (NASH)). The comparison group included 38 patients (16 patients with IR and 22 patients with T2DM). The condition of the blood flow in the brain was studied using ultrasound duplex scan of the extracranial portion of the common carotid artery (eCCA), the external carotid artery (eCA), the extracranial portion of the internal carotid artery, middle cerebral artery, the vertebral artery (VA), ophthalmic artery. The peak systolic velocity (PSV) and the time-average maximum (TAMX) of blood flow velocity in the studied vessels was determined. Results. The asymmetric damage to the vessels of the brain with more severe left ventricular dysfunction with NAFH is conspicuous; it is more pronounced in patients with the NASH stage, especially in combination with IR. Hemodynamically, the most significant changes were found in eCCA, namely, the decrease in PSV was found to be 38.1 ± 2.3 cm/s on the right, and 36.6 ± 3.4 cm/s on the left, TAMX reduction 20.4 ± 2.1 cm/s on the right, and 16.7 ± 1.8 cm/s on the left. Conclusions. The patients with NAFLD, as well as IR and T2DM had a decrease in the speed of blood flow in extracranial vessels of the brain, mainly in the eCCA, eCA and VA (segment 3). The most pronounced blood flow deficiency has been observed in patients with NASH in combination with IR, mainly on the left, especially in еCCA., Актуальність. Дослідження судин головного мозку в пацієнтів iз неалкогольною жировою хворобою печінки (НАЖХП) може розкрити нові аспекти щодо раннього виявлення порушень церебральної гемодинаміки, а також дозволить визначити групу хворих високого ризику. Мета дослідження: дослідити особливості зміни судин головного мозку в пацієнтів iз НАЖХП у поєднанні з інсулінорезистентністю (ІР) чи цукровим діабетом (ЦД) 2 типу. Матеріали та методи. Обстежено 74 пацієнтів iз НАЖХП (34 хворі з неалкогольним жировим гепатозом (НАЖГ) та 40 хворих з неалкогольним стеатогепатитом (НАСГ)). Група порівняння включала 38 пацієнтів (16 хворих з ІР та 22 пацієнтів з ЦД 2 типу). Стан кровотоку в cудинах головного мозку вивчали за допомогою ультразвукового дуплексного сканування екстракраніального відділу загальної сонної артерії (ЗагСА), зовнішньої сонної артерії (ЗовСА), екстракраніального відділу внутрішньої сон­ної артерії, середньої мозкової артерії, вертебральної артерії (ВА), очної артерії. Визначали пікову систолічну швидкість (ПСШ) та середню за часом максимальну швидкість кровотоку (ТАМХ) в досліджуваних судинах. Результати. Звертає на себе увагу асиметричне ураження судин головного мозку з більш вираженим дефіцитом кровотоку зліва при НАЖХП, що більш виражене у хворих зі стадією НАСГ, особливо у поєднанні з ІР. Гемодинамічно найбільш значущі зміни встановлено в ЗагСА, а саме виявлене зниження ПСШ до (38,1 ± 2,3) см/с справа та до (36,6 ± 3,4) см/с зліва, зниження ТАМХ — до (20,4 ± 2,1) см/с справа та до (16,7 ± 1,8) см/с зліва. Висновки. У хворих із НАЖХП, а також із ІР та ЦД 2 типу виявлене зниження швидкісних показників кровотоку по екстракраніальних судинах головного мозку, переважно по ЗагСА, ЗовСА та ВА (сегмент 3). Найбільш виражений дефіцит кровотоку встановлений у хворих на НАСГ у поєднанні з ІР, переважно зліва, особливо по ЗагСА.

Traumatic brain injury (TBI) is one of the top three specific neurological disorders, requiring reliable, rapid, and sensitive imaging of brain vessels, tissues, and cells for effective diagnosis and treatment. Although the use of medical imaging such as computed tomography (CT) and magnetic resonance imaging (MRI) for the TBI detection is well established, the exploration of novel TBI imaging techniques is of great interest. In this review, recent advances in fluorescence imaging for the diagnosis and evaluation of TBI are summarized and discussed in three sections: imaging of cerebral vessels, imaging of brain tissues and cells, and imaging of TBI-related biomarkers. Design strategies for probes and labels used in TBI fluorescence imaging are also described in detail to inspire broader applications. Moreover, the multimodal TBI imaging platforms combining MRI and fluorescence imaging are also briefly introduced. It is hoped that this review will promote more studies on TBI fluorescence imaging, and enable its use for clinical diagnosis as early as possible, helping TBI patients get better treatment and rehabilitation.

Segmenting 3D brain vessels on computed tomographic angiography is critical for early diagnosis of stroke. However, traditional filter and optimization-based methods are ineffective in this challenging task due to imaging quality limits and structural complexity. And learning based methods are difficult to be used in this task due to extremely high time consumption in manually labeling and the lack of labelled open datasets. To address this, in this paper, we develop an asymmetric encoding and decoding-based convolutional neural network for accurate vessel segmentation on computed tomographic angiography. In the network, 3D encoding module is designed to comprehensively extract 3D vascular structure information. And three 2D decoding modules are designed to optimally identify vessels on each 2D plane, so that the network can learn more complex vascular structures, and has stronger ability to distinguish vessels from normal regions. What is more, to improve insufficient fine vessel segmentation caused by pixel-wise loss function, we develop a centerline loss to guide learning model to pay equal attention to small vessels and large vessels, so that the segmentation accuracy of small vessels can be improved. Compared to two state-of-the-art approaches, our model achieved superior performance, demonstrating the effectiveness of both whole vessel segmentation and small vessel maintenance.

Cerebrovascular diseases are one of the leading causes of death worldwide, however, little progress has been made in preventing or treating these diseases to date. The transforming growth factor-β (TGF-β) signaling pathway plays crucial and highly complicated roles in cerebrovascular development and homeostasis, and dysregulated TGF-β signaling contributes to cerebrovascular diseases. In this review, we provide an updated overview of the functional role of TGF-β signaling in the cerebrovascular system under physiological and pathological conditions. We discuss the current understanding of TGF-β signaling in cerebral angiogenesis and the maintenance of brain vessel homeostasis. We also review the mechanisms by which disruption of TGF-β signaling triggers or promotes the progression of cerebrovascular diseases. Finally, we briefly discuss the potential of targeting TGF-β signaling to treat cerebrovascular diseases.

Consider high-resolution arterial wall imaging in the diagnosis of CNS vasculitis even in the absence of any arterial stenosis.

Severe traumatic brain injury (TBI) produces shearing forces on long-range axons and brain vessels, causing axonal and vascular injury. To examine whether microbleeds and axonal injury colocalize after TBI, we performed whole-brain susceptibility-weighted imaging (SWI) and diffusion tensor imaging (DTI) in 14 patients during the subacute phase after severe TBI. SWI was used to determine the number and volumes of microbleeds in five brain regions: the frontotemporal lobe; parieto-occipital lobe; midsagittal region (cingular cortex, parasagittal white matter, and corpus callosum); deep nuclei (basal ganglia and thalamus); and brainstem. Averaged fractional anisotropy (FA) and mean diffusivity (MD) were measured to assess microstructural changes in the normal appearing white matter attributed to axonal injury in the same five regions. Regional expressions of microbleeds and microstructure were used in a partial least-squares model to predict the impairment of consciousness in the subacute stage after TBI as measured with the Coma Recovery Scale-Revised (CRS-R). Only in the midsagittal region, the expression of microbleeds was correlated with regional changes in microstructure as revealed by DTI. Microbleeds and microstructural DTI-based metrics of deep, but not superficial, brain regions were able to predict individual CRS-R. Our results suggest that microbleeds are not strictly related to axonal pathology in other than the midsagittal region. While each measure alone was predictive, the combination of both metrics scaled best with individual CRS-R. Structural alterations in deep brain structures are relevant in terms of determining the severity of impaired consciousness in the acute stage after TBI.

Background One of the potentially important applications of three-dimensional (3D) intracranial vessel wall (IVW) cardiovascular magnetic resonance (CMR) is to monitor disease progression and regression via quantitative measurement of IVW morphology during medical management or drug development. However, a prerequisite for this application is to validate that IVW morphologic measurements based on the modality are reliable. In this study we performed comprehensive reliability analysis for the recently proposed whole-brain IVW CMR technique. Methods Thirty-four healthy subjects and 10 patients with known intracranial atherosclerotic disease underwent repeat whole-brain IVW CMR scans. In 19 of the 34 subjects, two-dimensional (2D) turbo spin-echo (TSE) scan was performed to serve as a reference for the assessment of vessel dimensions. Lumen and wall volume, normalized wall index, mean and maximum wall thickness were measured in both 3D and 2D IVW CMR images. Scan-rescan, intra-observer, and inter-observer reproducibility of 3D IVW CMR in the quantification of IVW or plaque dimensions were respectively assessed in volunteers and patients as well as for different healthy subjectsub-groups (i.e. 0.75). In addition, all ICCs of patients were equal to or higher than that of healthy subjects except maximum wall thickness. In volunteers, all ICCs of the age group of ≥50 years were equal to or higher than that of the age group of

During postnatal period, the causes of progressing heart failure are not only the inborn defects or cardiac rhythm disorders, but extracardiac diseases as well. Among such pathologies are the arterial-venous malformations of the brain vessels, including vena Galeni aneurysm. Inside the aneurysmatic sacks of the brain vessels, up to 80% of blood ejected from the left ventricle could be shunted, which leads then through the right chambers and causes heart failure and pulmonary hypertension. Recent drug treatment makes it to effectively treat pulmonary hypertension, compensate the signs of heart failure and stabilize the condition of a newborn before surgery. The case presented, is a bright evidence of this.

Purpose To propose and evaluate a parameter tune-up solution to expedite a three-dimensional (3D) variable-flip-angle turbo spin-echo (TSE) sequence for whole-brain intracranial vessel wall (IVW) imaging. Materials and Methods Elliptical k-space sampling and prolonged echo train length (ETL), were used to expedite a 3D variable-flip-angle TSE-based sequence. To compensate for the potential loss in vessel wall signal, optimal combination of prescribed T2 and ETL was experimentally investigated on 22 healthy volunteers at 3 Tesla. The optimized protocol (7–8 min) was then compared with a previous protocol (reference protocol, 11–12 min) in terms of signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), vessel wall sharpness, and wall delineation quality on a 4-point scale (0:poor; 3:excellent) in 10 healthy volunteers. A pilot study of five patients was performed and lesion delineation score was used to demonstrate the diagnostic quality. Results A protocol with ETL = 52 and prescribed T2 = 170 ms was deemed an optimized one, which, compared with the reference protocol, provided significantly improved wall SNR (12.0 ± 1.3 versus 10.0 ± 1.1; P = 0.002), wall–lumen CNR (9.7 ± 1.2 versus 8.0 ± 0.9; P = 0.002), wall–CSF CNR (2.8 ± 1.0 versus 1.7 ± 1.0; P = 0.026), similar vessel wall sharpness at both inner (1.59 ± 0.18 versus 1.58 ± 0.14, P = 0.87) and outer (1.71 ± 0.25 versus 1.83 ± 0.30; P = 0.18) boundaries, and comparable vessel wall delineation score for individual segments (1.95–3; P > 0.06). In all patients, atherosclerotic plaques (10) or wall dissection (5) were identified with a delineation score of 3 or 2. Conclusion A parameter tune-up solution can accelerate 3D variable-flip-angle TSE acquisitions, particularly allowed for expedited whole-brain IVW imaging with preserved wall delineation quality. Level of Evidence: 2. J. Magn. Reson. Imaging 2017.

Cerebral arteriovenous malformation (AVM) is a congenital brain vessels pathology, in which the arterial and venous blood channels are connected by tangles of abnormal blood vessels. It is a dangerous disease that affects brain functioning causing the high risk of intracerebral haemorrhage. One of AVM treatment methods is embolization—the endovascular filling of the AVM vessel bundle with a special embolic agent. This method is widely used, but still in some cases is accompanied by intraoperative AVM vessels rupture. In this paper, the optimal scenario of AVM embolization is studied from the safety and effectiveness of the procedure point of view. The co-movement of blood and embolic agent in the AVM body is modelled on the basis of a one-dimensional two-phase filtration model. Optimal control problem with phase constraints arising from medicine is formulated and numerically solved. In numerical analysis, the monotone modification of the CABARET scheme is used. Optimal embolization model is constructed on the basis of real patients' clinical data collected during neurosurgical operations. For the special case of embolic agent, input admissible and optimal embolization scenarios were calculated.

Cerebrovascular reactivity (CVR), an index of brain vessel’s dilatory capacity, is typically measured using hypercapnic gas inhalation or breath-holding as a vasoactive challenge. However, these methods require considerable subject cooperation and could be challenging in clinical studies. More recently, there have been attempts to use resting-state BOLD data to map CVR by utilizing spontaneous changes in breathing pattern. However, in subjects who have small fluctuations in their spontaneous breathing pattern, the CVR results could be noisy and unreliable. In this study, we aim to develop a new method for CVR mapping that does not require gas-inhalation yet provides substantially higher sensitivity than resting-state CVR mapping. This new method is largely based on resting-state scan, but introduces intermittent modulation of breathing pattern in the subject to enhance fluctuations in their end-tidal CO2 (EtCO2) level. Here we examined the comfort level, sensitivity, and accuracy of this method in two studies. First, in 8 healthy young subjects, we developed the intermittent breath-modulation method using two different modulation frequencies, 6 ​s per breath and 12 ​s per breath, respectively, and compared the results to three existing CVR methods, specifically hypercapnic gas inhalation, breath-holding, and resting-state. Our results showed that the comfort level of the 6-s breath-modulation method was significantly higher than breath-holding (p ​= ​0.007) and CO2-inhalation (p ​= ​0.015) methods, while not different from the resting-state, i.e. free breathing method (p ​= ​0.52). When comparing the sensitivity of CVR methods, the breath-modulation methods revealed higher Z-statistics compared to the resting-state scan (p ​

The basement membrane (BM) is an important element of the neurovascular unit acting as a mechanical barrier. It is also essential to maintain blood–brain barrier (BBB) integrity and to regulate ang...

Astrocytes send out long processes that are terminated by endfeet at the vascular surface and regulate vascular functions in particular through the expression of a specific molecular repertoire in perivascular endfeet. We recently proposed that local translation might sustain this structural and functional polarization. More specifically we showed that a subset of mRNAs is distributed in astrocyte endfeet and characterized this transcriptome. We also identified among these endfeet RNAs, the ones bound to ribosomes, the polysomal astrocyte endfeet mRNAs, which we called the endfeetome. Here, we describe experimental strategies to identify mRNAs and polysomes in astrocyte perivascular endfeet, which are based on the combination of gliovascular unit purification and astrocyte-specific translating ribosome affinity purification.

Objectives: Intracranial arterial dolichoectasia (IADE) refers to the vascular abnormities of elongation, tortuous, and dilating of the brain vessels. The incidence of IADE in patients with ischemic cerebrovascular disease was higher, however, the prognosis of IADE in patients with ischemic cerebrovascular diseases was still not clear. The purpose of this study was to explore the association between the IADE and the clinical prognosis of patients with ischemic cerebrovascular disease in China. Methods: Patients with acute ischemic stroke and transient ischemic attack were enrolled in a prospective, multicenter cohort study. Baseline clinical information and follow-up information were collected. The imaging information of the patients (baseline magnetic resonance imaging) was collected, and IADE patients were selected through the centralized double-blinded interpretation. The endpoints included stroke recurrence, composite events, and all-cause mortality at 12 months. The multivariate Cox regression model was used to explore the association between IADE and the clinical prognosis of ischemic cerebrovascular disease. Results: 8219 patients with ischemic cerebrovascular disease were enrolled in this study, 395 patients of whom had IADE. Patients with IADE had a lower stroke recurrence rate (4.8% vs 7.8%, P=0.03) and lower composite events rate (5.3% vs 8.1%, P=0.04) at 12 months. The elongation of the basilar artery was also associated with stroke recurrence (6.8% vs 8.4%, P=0.009) and composite events rate (7.1% vs. 8.7%, P=0.009) at 12 months. After multivariate Cox regression, IADE was still independently associated with decreased stroke recurrence (HR 0.59, 95% CI 0.36-0.95,P=0.03) and composite events (HR 0.63, 95% CI 0.40-0.99,P=0.05) at 12 months . The elongation of the basilar artery was still independently associated with decreased stroke recurrence (HR 0.80, 95% CI 0.67-0.95, P=0.01) and composite events (HR 0.81, 95% CI 0.68-0.95, P=0.01) at 12 months. Conclusion: IADE and the elongation of the basilar artery were both independently associated with decreased stroke recurrence and composite events at 12 months.

Intracranial aneurysm rupture can cause a serious stroke, which is related to the decline of daily life ability of the elderly. Although deep learning is now the most successful solution for organ detection, it requires myriads of training data, consistent of the image format, and a balanced sample distribution. This work presents an innovative representation of intracranial aneurysm detection as a shape analysis problem rather than a computer vision problem. We detected intracranial aneurysms in 3D cerebrovascular mesh models after segmentation of the brain vessels from the medical images, which can overcome the barriers of data format and data distribution, serving both clinical and screening purposes. Additionally, we propose a transferable multi-model ensemble (MMEN) architecture to detect intracranial aneurysms from cerebrovascular mesh models with limited data. To obtain a well-defined convolution operator, we use a global seamless parameterization converting a 3D cerebrovascular mesh model to a planar flat-torus. In the architecture, we transfer the planar flat-torus presentation abilities of three GoogleNet Inception V3 models, which were pre-trained on the ImageNet database, to characterize the intracranial aneurysms with local and global geometric features such as Gaussian curvature (GC), shape diameter function (SDF) and wave kernel signature (WKS), respectively. We jointly utilize all three models to detect aneurysms with adaptive weights learning based on back propagation. The experimental results on the 121 models show that our proposed method can achieve detection accuracy of 95.1% with 94.7% F1-score and 94.8% sensitivity, which is as good as the state-of-art work but is applicable to inhomogeneous image modalities and smaller datasets.

> A ruddy clot, thick, viscous as fresh mud > > gets lodged within brain vessel. Language lobe, > > its thirst not slaked, vampiric quest for blood, > > succumbs, and like the emperor disrobed

The main goal was to evaluate effectiveness of a modified TSE sequence compared with DIR (double inversion recovery) sequence in acquisition of fast flow brain vessel images using signal void effect. 32 healthy volunteers (10 men and 22 women; mean age of 31 years; ranging between 28-43 years) who underwent black blood DIR sequence (group A) and the modified TSE sequence (group B) were enrolled in our study. Signal to Noise Ratio (SNR) and Contrast to Noise Ratio (CNR) of the internal carotid arteries’ lumen were compared in T1 and T2 weighted images for both group A and B. The images obtained from group B showed lower SNR values in internal carotid artery than the group A in both of the T1 and T2 weighted images (11.49% and 13.66% respectively). While the CNR values were higher in the group B than the group A in both of the T1 and T2 weighted images (8.69% and 7.55 % respectively). The qualitative score of all categories were not significantly different between the two groups. Furthermore approximately 49% of the total scan time was reduced from group B. Our study is to shorten the scanning time and minimize the inconveniences of the patients in acquisition of the black blood images of brain by using the signal void effect in the modified TSE technique while keeping the diagnostic value of the test.