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Diagnostics
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Cerebrovascular Lesions: Diagnosis and Management, 2nd Edition
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Cerebrovascular Lesions: Diagnosis and Management, 2nd Edition

A special issue of Diagnostics (ISSN 2075-4418). This special issue belongs to the section "Clinical Diagnosis and Prognosis".

Deadline for manuscript submissions: 31 March 2026 | Viewed by 3983

Special Issue Editor

Dr. Hung-Chieh Chen

E-Mail Website
Guest Editor
1. Division of Neuroradiology, Department of Radiology, Taichung Veterans General Hospital, Taichung 40705, Taiwan
2. School of Medicine, National Yang-Ming Chiao Tung University, Taipei 11221, Taiwan
Interests: neuroimaging; diagnostic neuroradiology; pediatric neuroradiology; spine images
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Cerebrovascular diseases and stroke are the fifth leading cause of death worldwide. Survivors often suffer from significant morbidity or complications. Cerebrovascular diseases can develop from a variety of causes, including atherosclerosis, thrombosis, embolic events, or vascular lesions. Accurate diagnosis and proper management are important to achieve better outcomes and decrease complications.

The goal of this Special Issue is to collect studies that focus on the pathophysiology, diagnostic methods, potential pitfalls, and treatment methods of cerebrovascular diseases. Thus, this Special Issue will provide insight into the latest medical progress in cerebrovascular diseases and could establish the foundation for advanced future studies. We welcome the submission of original research articles, focused reviews, and pictorial essays or case reports focusing on the pathophysiology, diagnosis, treatment, and prognostic evaluation of cerebrovascular diseases.

Dr. Hung-Chieh Chen
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Diagnostics is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • stroke
  • aneurysm
  • vascular malformation
  • computed tomography (CT)
  • magnetic resonance imaging (MRI)

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Related Special Issue

Published Papers (5 papers)

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Research

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16 pages, 860 KB  
Article
Impact of Preprocedural Collateral Status on Hemorrhagic Transformation and Outcomes After Endovascular Thrombectomy in Acute Ischemic Stroke
by Shiu-Yuan Huang, Nien-Chen Liao, Jin-An Huang, Wen-Hsien Chen and Hung-Chieh Chen
Diagnostics 2025, 15(21), 2701; https://doi.org/10.3390/diagnostics15212701 - 25 Oct 2025
Viewed by 408
Abstract
Background: Hemorrhagic transformation (HT) is a major complication of endovascular thrombectomy (EVT) for acute ischemic stroke (AIS). Objectives: To investigate the factors as sociated with HT in patients with successful recanalization and examine the impact of collateral status (CS) on ischemic [...] Read more.
Background: Hemorrhagic transformation (HT) is a major complication of endovascular thrombectomy (EVT) for acute ischemic stroke (AIS). Objectives: To investigate the factors as sociated with HT in patients with successful recanalization and examine the impact of collateral status (CS) on ischemic progression and outcomes. Methods: We retrospectively analyzed patients with AIS with successful recanalization (modified treatment in cerebral infarction (mTICI) 2B-3) who underwent dual-energy CT (DECT) within 24 h and MRI within 10 days post-EVT. Patients with posterior circulation stroke, missing multiphase CT angiography (CTA) collateral scores, or missing 3-month modified ranking scale scores were excluded from the study. Results: Among the 86 patients, those with HT had a significantly lower proportion of 3-month excellent outcomes and worse imaging scores, including non-contrast CT (NCCT)-Alberta Stroke Program Early CT Score (ASPECTS), virtual non-contrast (VNC)-ASPECTS, and diffusion-weighted imaging (DWI)-ASPECTS. Patients with HT with poor CS had a significantly lower proportion of 3-month excellent outcomes, poorer post-EVT National Institutes of Health Stroke Scale (NIHSS) score, worse imaging scores, including VNC-ASPECTS, and DWI-ASPECTS. In the predictive factor analysis, post-EVT NIHSS and VNC-ASPECTS scores were significantly associated with 3-month excellent functional outcomes (modified Rankin Scale (mRS) 0-1). Conclusions: In patients with successfully recanalized AIS, HT with poor CS was associated with poorer functional outcomes and worse imaging scores, and a 24 h combined measure (post-EVT NIHSS and DECT VNC-ASPECT) show promise for early risk stratification; prospective external validation is warranted before routine use. Full article
(This article belongs to the Special Issue Cerebrovascular Lesions: Diagnosis and Management, 2nd Edition)
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16 pages, 1415 KB  
Article
Fractal-Based Quantitative Collateral Assessment for Thrombectomy Candidate Selection in Acute Ischemic Stroke: A Preliminary Study
by Chien-Hung Chang, Chi-Ming Ku, Tzong-Rong Ger and Wen-Piao Lin
Diagnostics 2025, 15(13), 1590; https://doi.org/10.3390/diagnostics15131590 - 23 Jun 2025
Viewed by 619
Abstract
Background: Acute ischemic stroke (AIS) remains a leading cause of mortality and disability worldwide. Accurate evaluation of collateral circulation is essential for predicting outcomes following endovascular thrombectomy (EVT). However, conventional visual collateral scoring (vCS) based on multiphase CT angiography (mCTA) is limited [...] Read more.
Background: Acute ischemic stroke (AIS) remains a leading cause of mortality and disability worldwide. Accurate evaluation of collateral circulation is essential for predicting outcomes following endovascular thrombectomy (EVT). However, conventional visual collateral scoring (vCS) based on multiphase CT angiography (mCTA) is limited by subjectivity and inter-observer variability. This preliminary study introduces the multiphase quantitative collateral score (mqCS), a novel imaging biomarker designed to provide an objective and reproducible assessment of both the morphological extent and temporal dynamics of collateral flow. Methods: In this exploratory study, 54 AIS patients treated with EVT were retrospectively analyzed. Collateral status was evaluated using both vCS (graded by two blinded neuroradiologists) and mqCS, derived from mCTA-based fractal dimension (FD) and delay indicator (DI) metrics. Logistic regression and receiver operating characteristic (ROC) analyses were performed to assess the predictive value of each scoring system for favorable 90-day functional outcomes (modified Rankin scale, mRS ≤ 2). Results: The mqCS was significantly associated with favorable outcomes. Patients with mqCS ≥ 0.8674 had significantly higher odds of achieving favorable outcomes (adjusted OR = 5.98, 95% CI: 1.38–25.93, p = 0.017; AUC = 0.80). In comparison, the visual collateral score (vCS) showed a lower adjusted predictive value (adjusted OR = 2.84, 95% CI: 1.17–6.89, p = 0.02; AUC = 0.79). Patients in the highest mqCS quartiles (Q3–Q4) exhibited significantly better recovery rates (69%, p < 0.01). Conclusions: This proof-of-concept study suggests that mqCS provides a potentially more objective and robust alternative to visual scoring for collateral assessment in AIS. By integrating structural and temporal characteristics, mqCS enhances outcome prediction and may inform EVT decision-making, particularly in borderline cases. These preliminary findings warrant validation in larger, prospective cohorts and support its potential integration into automated imaging platforms. Full article
(This article belongs to the Special Issue Cerebrovascular Lesions: Diagnosis and Management, 2nd Edition)
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Other

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21 pages, 2910 KB  
Case Report
Perforator-Sparing Microsurgical Clipping of Tandem Dominant-Hemisphere Middle Cerebral Artery Aneurysms: Geometry-Guided Reconstruction of a Wide-Neck Bifurcation and Dorsal M1 Fusiform Lesion
by Matei Șerban, Corneliu Toader and Răzvan-Adrian Covache-Busuioc
Diagnostics 2025, 15(21), 2678; https://doi.org/10.3390/diagnostics15212678 - 23 Oct 2025
Viewed by 314
Abstract
Background and Clinical Significance: Tandem pathology at the dominant-hemisphere middle cerebral artery (MCA)—combining a wide-neck bifurcation aneurysm that shares the neck with both M2 origins and a short dorsal M1 fusiform dilation embedded in the lenticulostriate belt—compresses the therapeutic margin and complicates device-first [...] Read more.
Background and Clinical Significance: Tandem pathology at the dominant-hemisphere middle cerebral artery (MCA)—combining a wide-neck bifurcation aneurysm that shares the neck with both M2 origins and a short dorsal M1 fusiform dilation embedded in the lenticulostriate belt—compresses the therapeutic margin and complicates device-first pathways. We aimed to describe an anatomy-led, microscope-only sequence designed to secure an immediate branch-definitive result at the fork and to remodel dorsal M1 without perforator compromise, and to place these decisions within a pragmatic perioperative framework. Case Presentation: A 37-year-old right-handed man with reproducible, load-sensitive cortical association and capsulostriate signs underwent high-fidelity digital subtraction angiography (DSA) with 3D rotational reconstructions. Through a left pterional approach, vein-respecting Sylvian dissection achieved gravity relaxation. Reconstruction proceeded in sequence: a fenestrated straight clip across the bifurcation neck with the superior M2 encircled to preserve both M2 ostia, followed by a short longitudinal clip parallel to M1 to reshape the fusiform segment while keeping each lenticulostriate mouth visible and free. Temporary occlusion windows were brief (bifurcation 2 min 30 s; M1 < 2 min). No neuronavigation, intraoperative fluorescence, micro-Doppler, or intraoperative angiography was used. No perioperative antiplatelets or systemic anticoagulation were administered and venous thromboembolism prophylaxis followed institutional practice. The bifurcation dome collapsed immediately with round, mobile M2 orifices, and dorsal M1 regained near-cylindrical geometry with patent perforator ostia under direct inspection. Emergence was neurologically intact, headaches abated, and preoperative micro-asymmetries resolved without new deficits. The early course was uncomplicated. Non-contrast CT at three months showed structurally preserved dominant-hemisphere parenchyma without infarction or hemorrhage. Lumen confirmation was scheduled at 12 months. Conclusions: In dominant-hemisphere tandem MCA disease, staged, perforator-sparing clip reconstruction can restore physiologic branch and perforator behavior while avoiding prolonged antiplatelet exposure and device-related branch uncertainty. A future-facing pathway pairs subtle clinical latency metrics with high-fidelity angiography, reports outcomes in branch- and perforator-centric terms, and, where available, incorporates patient-specific hemodynamic simulation and noninvasive lumen surveillance to guide timing, technique, and follow-up. Full article
(This article belongs to the Special Issue Cerebrovascular Lesions: Diagnosis and Management, 2nd Edition)
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4 pages, 1288 KB  
Interesting Images
Gouty Tophi in Developed Countries: Uncovering Underlying Brain Diseases
by Koji Hayashi, Mamiko Sato, Yuka Nakaya, Maho Hayashi, Toyoaki Miura, Hidetaka Matsuda and Yasutaka Kobayashi
Diagnostics 2025, 15(19), 2424; https://doi.org/10.3390/diagnostics15192424 - 23 Sep 2025
Viewed by 356
Abstract
A 56-year-old man, accompanied by city hall staff, visited our neurorehabilitation clinic. Despite hyperuricemia being diagnosed several years ago, he refused treatment. He had no history of hypertension and antihypertensive drug use. He developed painful joint tophi around the age of 51, which [...] Read more.
A 56-year-old man, accompanied by city hall staff, visited our neurorehabilitation clinic. Despite hyperuricemia being diagnosed several years ago, he refused treatment. He had no history of hypertension and antihypertensive drug use. He developed painful joint tophi around the age of 51, which were managed with over-the-counter painkillers. At age 54, a knee tophus was removed, histologically confirming gouty tophi. Subsequently, he lost his chef’s job, and his lifestyle deteriorated. Gouty tophi were observed in the right ear, knuckles, elbows, and ankles, with some ulceration. Blood tests showed anemia and hyperuricemia (10.1 mg/dL: reference 3.6–7.0 mg/dL). Chest–abdominal CT demonstrated calcification of the aorta. Brain MRI revealed an old putaminal hemorrhage and numerous microbleeds. Dementia (Clinical Dementia Rating: 1) was diagnosed based on neuropsychological testing. Public services and social assistance were arranged for him. This case is hypothesis-generating. In settings with adequate healthcare access, the presentation of severe, uncontrolled gouty tophi with poor engagement should prompt a selective, stepwise evaluation—beginning with cognitive screening and proceeding to neurologic assessment if indicated; routine preventive brain imaging is not recommended. The presence of lobar and deep microbleeds should be interpreted within the context of standardized diagnostic criteria and lesion distribution patterns to inform differential diagnosis. Full article
(This article belongs to the Special Issue Cerebrovascular Lesions: Diagnosis and Management, 2nd Edition)
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9 pages, 2266 KB  
Brief Report
Assessment of Inter-Reader Reliability of Fazekas Scoring on Magnetic Resonance Imaging of the Brain in Adult Patients with Sickle Cell Disease
by Aoife M. Haughey, Roisin M. O’Cearbhaill, Stephanie Forté, Joanna D. Schaafsma, Kevin H. M. Kuo and Igor Gomes Padilha
Diagnostics 2025, 15(7), 857; https://doi.org/10.3390/diagnostics15070857 - 27 Mar 2025
Viewed by 1823
Abstract
Background/Objectives: Cerebral white matter disease is a common finding in patients with sickle cell that has been linked to cognitive impairment. However, there is no standardized approach for quantification of the cerebral disease burden. The Fazekas score is widely used to quantify [...] Read more.
Background/Objectives: Cerebral white matter disease is a common finding in patients with sickle cell that has been linked to cognitive impairment. However, there is no standardized approach for quantification of the cerebral disease burden. The Fazekas score is widely used to quantify the burden of white matter disease in chronic small vessel disease. However, its utility in sickle cell disease, specifically the inter-rater variability, has not been established. Methods: A patient cohort was compiled for the purpose of a research ethics board (REB)-approved retrospective study of adult patients with sickle cell disease, each of whom underwent MRI/MRA between the years 2017 and 2019. A total of 90 such patients were captured. All MRI/MRA studies were performed on three Tesla MRIs. Two independent neuroradiologists assessed the axial FLAIR MRI brain sequence (see image 1) for each of the 90 patients, with the sole focus of assigning a Fazekas score (0–3) to each study as a means of quantifying the burden of ischemic white matter lesions. The neuroradiologists were blinded to the scoring assigned by their counterpart and to the clinical information. After the initial assessment was completed, studies with discrepant Fazekas scores were documented and discussed by both readers. A consensus Fazekas score was then assigned to each of these studies. Results: Cohen’s weighted kappa was used as a measure of agreement between readers. The expected agreement was 74.65%, with an observed agreement of 94.44% between readers, with a kappa of 0.7808. Conclusions: We conclude on the basis of our study that there is good inter-reader reliability of Fazekas scoring on axial FLAIR MRI brain sequence in patients with sickle cell disease. The Fazekas is a promising measure that could easily be integrated in systematic evaluation of cerebrovascular lesions of adults with sickle cell disease. Full article
(This article belongs to the Special Issue Cerebrovascular Lesions: Diagnosis and Management, 2nd Edition)
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