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Articles by Max Wintermark
Current State of Artificial Intelligence Adoption and Implementation in Neuroradiology Departments: Insights from a US National Survey
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Quality of Evidence and Clinical Impact in Recent Neuroradiology Research: A Systematic Assessment of American Journal of Neuroradiology Articles
Abstract BACKGROUND AND PURPOSE: Evidence-based medicine frameworks in radiology emphasize rigorous study design and clinical applicability, yet the extent to which neuroradiology research aligns with these standards remains unclear. This study aimed to evaluate the methodologic quality and clinical relevance of recent American Journal of Neuroradiology (AJNR) publications by assessing their evidence level (EL) and clinical efficacy (CE).
Chemical Angioplasty Alone versus Chemical and Mechanical Angioplasty for Cerebral Vasospasm after Aneurysmal Hemorrhage: A Pilot Randomized Controlled Study
Abstract BACKGROUND AND PURPOSE: Refractory cerebral vasospasm (CV) and delayed cerebral ischemia after aneurysmal SAH are associated with high morbidity and mortality; CV may recur despite intra-arterial chemical treatment and the role of mechanical angioplasty remains unclear. We aim to define the role of mechanical angioplasty in addition to chemical angioplasty.
The Precision Mental Health Commission: transforming mental health through brain circuit science
This Comment announces the Precision Mental Health Commission and its initiative to redefine mental disorders through brain circuit function analysis, promoting stratified, circuit-informed care that enhances treatment accuracy and efficiency. The approach mirrors advances in cardiovascular and cancer research, moving beyond trial and error toward personalized care.
Efficacy and Safety of Flow Diversion for Distal Anterior Cerebral Aneurysms: A Systematic Review and Proportional Meta-Analysis
Abstract BACKGROUND: Flow diverters (FDs) are increasingly used off-label for the treatment of distal anterior cerebral artery aneurysms (DACAAs), located at or beyond the A2 segment of the anterior cerebral artery (ACA). However, data on safety and efficacy remain limited. PURPOSE: To evaluate the safety and efficacy of FDs for the treatment of DACAAs through a systematic review and meta-analysis.
Clinical and Imaging Features of Primary Intradural Extramedullary Ewing Sarcoma
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Adoption of the T2-FLAIR Mismatch Sign among Radiologists: How Well Are We Doing?
Abstract BACKGROUND AND PURPOSE: The classic T2-FLAIR mismatch sign is a highly specific MRI feature that can aid in preoperative diagnosis of isocitrate dehydrogenase (IDH)-mutant 1p/19q noncodeleted gliomas and affect surgical planning.
Adoption of the T2-FLAIR Mismatch Sign Among Radiologists: How Well Are We Doing?
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Altered Functional Connectivity and Amyloid Deposition in Posttraumatic Stress Disorder-Associated Cognitive Impairment
Abstract BACKGROUND AND PURPOSE: Posttraumatic stress disorder (PTSD) has been linked to an increased risk of cognitive impairment and dementia, with neuroinflammation, metabolic dysfunction, and neuropathologic markers such as β-amyloid and τ implicated as potential mechanisms.
Supporting Imaging Research: A Framework for Equity and Excellence in Neuroradiology
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Financial Compensation of PhD Research Faculty in Academic Radiology: Trends and Disparities in the U.S.
Key Words Radiology Compensation Research Faculty Academic Get full text access Log in, subscribe or purchase for full access. References 1. Malhotra, A. The future of academic neuroradiology: challenges, opportunities, and way forward AJNR Am J Neuroradiol. 2024; 45:1834-1837 2. Jackson, V.P. 2019 RSNA Outstanding Researcher Radiology. 2019; 293:489 3. Hricak, H. 2010 RSNA Outstanding Researcher Radiology. 2010; 256:599-600 4. Haffty, B.G. 2022 RSNA Outstanding Researcher Radiology. 2023; 306:4 5.
Apixaban to Prevent Covert Infarcts After Cryptogenic Stroke in Patients With Atrial Cardiopathy: A Secondary Analysis of the ARCADIA Randomized Clinical Trial | Cerebrovascular Disease | JAMA Neurology | JAMA Network
Apixaban to Prevent Covert Infarcts After Cryptogenic Stroke in Patients With Atrial Cardiopathy: A Secondary Analysis of the ARCADIA Randomized Clinical Trial Key Points Question Is apixaban superior to aspirin at preventing nonlacunar covert infarcts among patients with a recent cryptogenic stroke and atrial cardiopathy?
Bracco MRI | Applied Radiology
Clinical Applications of Gadopiclenol in Neuro MRI By Laura Eisenmenger, MD; Aaron Field, MD, PhD October 29, 2024 06:00 PM UTC Bracco MR• Breast Imaging• CME• CRA• MR Contrast• MRI Bracco MR Margarita L.
Association between Body Mass Index and Brain Health in Adults: A 16-Year Population-Based Cohort and Mendelian Randomization Study | Health Data Science | Flipboard
Say you’re facing a difficult problem at work, and even though you’ve been sitting at your desk for the last 10 minutes straining your brain to think of a solution, you’re still coming up blank. What do you do? If you happened to be Steve Jobs, the answer to this question would be simple. You’d stand …
Academic Neuroradiology: 2023 Update on Turnaround Time, Financial Recruitment, and Retention Strategies
Academic Neuroradiology: 2023 Update on Turnaround Time, Financial Recruitment, and Retention Strategies Max Wintermark, Jason W. Allen, Rahul Bhala, Amish H. Doshi, Sugoto Mukherjee, Joshua Nickerson, Jeffrey B. Rykken, Vinil Shah, Jody Tanabe, Tabassum Kennedy American Journal of Neuroradiology Sep 2024, DOI: 10.3174/ajnr.A8321
Clinical Applications in MRI: Managing Patient Outcomes
SponsoredBody ImagingBreast ImagingCardiopulmonary ImagingGastrointestinalNeuro ImagingOncologic Imaging Published Date: April 8, 2025 Introduction Gadolinium-based contrast agents (GBCAs) are indispensable to MR imaging, as they enhance patient care through detailed visualization of tissue and vascular abnormalities.1 GBCAs have faced two areas of concern over the last 20 years.2 The first is nephrogenic systemic fibrosis (NSF) in patients with severe renal insufficiency, the incidence of...
Evidence of varicella zoster virus reactivation in children with arterial ischemic stroke: Results of the VIPS II Study
The authors have declared no competing interest. Supported by NIH (R01 NS104094, PI Fullerton) I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.
Imaging Features of Primary Intracranial Sarcoma with DICER1 Mutation: A Multicenter Case Series
Imaging Features of Primary Intracranial Sarcoma with DICER1 Mutation: A Multicenter Case Series Rami W. Eldaya, Richard J. Fagan, Samir A. Dagher, Angshumoy Roy, Sonika Dahyia, Gregory N. Fuller, Max Wintermark, Matthew S. Parsons, Thierry A.G.M. Huisman American Journal of Neuroradiology Apr 2024, DOI: 10.3174/ajnr.A8192
A Clinical and Imaging Fused Deep Learning Model Matches Expert Clinician Prediction of 90-Day Stroke Outcomes
ABBREVIATIONS: AC Agreement CoefficientACC accuracy±1ACC mRS accuracy within ±1 scoreAIS acute ischemic strokeAUC area under the curveDL deep learningDLPD deep learning–based predictive modelIQR interquartile rangeMAE mean absolute errorROC receiver operating characteristic Footnotes Y. Liu and P. Shah contributed equally to this work.
Diversity in Radiology Residents Relative to Other Specialties- Trends Over the Past Decade
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Roundtable Recap: Imaging Biomarkers for the Early Diagnosis of Alzheimer’s Disease
Image Gallery Roundtable Recap: Imaging Biomarkers for the Early Diagnosis of Alzheimer’s Disease. Appl Radiol.
Cerebrovascular Collateral Integrity in Pediatric Large Vessel Occlusion
Cerebrovascular Collateral Integrity in Pediatric Large Vessel Occlusion Analysis of the Save ChildS Study Sarah Lee, Bin Jiang, Max Wintermark, Michael Mlynash, Soren Christensen, Ronald Sträter, Gabriel Broocks, Astrid Grams, Franziska Dorn, Omid Nikoubashman, Daniel Kaiser, Andrea Morotti, Ulf Jensen-Kondering, Johannes Trenkler, Markus Möhlenbruch, Jens Fiehler, Moritz Wildgruber, André Kemmling, Marios Psychogios, Peter B.
An Underestimated Source
Abstract and Introduction Abstract The term 'embolic stroke of undetermined source' (ESUS) is used to describe patients with a non-lacunar ischaemic stroke without any identified embolic source from the heart or the arteries supplying the ischaemic territory, or any other apparent cause. When the ESUS concept was introduced, covert atrial fibrillation was conceived to be the main underlying cause in the majority of ESUS patients.
Predicted Cost Savings Achieved by the Radiology Support, Communication and Alignment Network from Reducing Medical Imaging Overutilization in the Medicare Population
Abstract Objective The Radiology Support, Communication and Alignment Network (R-SCAN) is a quality improvement program through which patients, referring clinicians, and radiologists collaborate to improve imaging appropriateness based on Choosing Wisely recommendations and ACR Appropriateness Criteria. R-SCAN was shown previously to increase the odds of obtaining an appropriate, higher patient or diagnostic value, imaging study.
Everything Every Radiologist Always Wanted (and Needs) to Know About Clinical Decision Support
To view the full text, please login as a subscribed user or purchase a subscription. Click here to view the full text on ScienceDirect. Abstract As of January 2020, clinical decision support needs to be implemented across US health systems for advanced diagnostic imaging services. This article reviews the history, importance, and hurdles of clinical decision support and discusses a few pearls and pitfalls regarding its implementation.
The influence of the volumetric composition of the intracranial space on neural activity in healthy subjects: a resting‐state functional magnetic resonance study
RESEARCH REPORT Michele Porcu Corresponding Author E-mail address: micheleporcu87@gmail.com E-mail address: m.porcu@aoucagliari.it https://orcid.org/0000-0002-3090-8541 Department of Medical Imaging, AOU of Cagliari, University of Cagliari, Italy Corresponding author Michele Porcu Department of Medical Imaging, Azienda Ospedaliera Universitaria di Cagliari – S.S. 554, km 4.500 – CAP: 09042 – Monserrato (Cagliari, Italy) (E‐mail: micheleporcu87@gmail.com / institutional mail:...
White matter asymmetry: a reflection of pathology in traumatic brain injury.
Abstract Comparisons of white matter (WM) fractional anisotropy (FA) values between mild traumatic brain injury (mTBI) patients and controls have revealed inconsistencies in the directions of the resulting FA changes. To address these discrepancies, we examined hemispheric FA symmetry levels across WM tracts in 150 mTBI patients relative to 96 military controls.
The vast potential and bright future of neuroimaging
Quantitative Neuroimaging Medical images traditionally relied on subjective visual interpretation by a radiologist. With the rapid growth of modern neuroimaging modalities, such as CT, MRI, positron emission tomography (PET) and single-photon emission CT, assessment of cerebral tissue and function can now be assessed quantitatively. Importantly, this unlocks the potential for unbiased and reproducible evaluation.
Reduced Intravoxel Incoherent Motion Microvascular Perfusion Predicts Delayed Cerebral Ischemia and Vasospasm After Aneurysm Rupture
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Parvovirus B19 Infection in Children With Arterial Ischemic Stroke
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Safety of Computed Tomographic Angiography in the Evaluation of Patients With Acute Stroke
Background and Purpose—Noncontrasted head computed tomography (NCHCT) has long been the standard of care for acute stroke imaging. New guidelines recommending advanced vascular imaging to identify eligible patients for endovascular therapy have renewed safety concerns on the use of contrast in the emergent setting without laboratory confirmation of renal function.
Acute Stroke Imaging Research Roadmap III Imaging Selection and Outcomes in Acute Stroke Reperfusion Clinical Trials
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An Appendix of the general contributors is available in the online-only Data Supplement. Background and Purpose—The Stroke Imaging Research (STIR) group, the Imaging Working Group of StrokeNet, the American Society of Neuroradiology, and the Foundation of the American Society of Neuroradiology sponsored an imaging session and workshop during the Stroke Treatment Academy Industry Roundtable (STAIR) IX on October 5 to 6, 2015 in Washington, DC.
By Steven Warach, Gregory W. Albers, Roland Bammer, Andrew Bivard, Bruce Campbell, Colin P. Derdeyn, Pooja Khatri, David S. Liebeskind, Charles B. L. M. Majoie, Michael Marks Verified, Bijoy K. Menon, Keith Muir, Mark Parsons, Achala Vagal, Albert J. Yoo, Jean-Claude Baron, David Fiorella, Josep Puig, Peter D. Schellinger, Max Wintermark, Marie Luby, Jeremy J. Heit, Maarten G. Lansberg, Andrei V. Alexandrov, Anthony J. Furlan
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stroke.ahajournals.org
Arterial Tortuosity: An Imaging Biomarker of Childhood Stroke Pathogenesis?
Background and Purpose—Arteriopathy is the leading cause of childhood arterial ischemic stroke. Mechanisms are poorly understood but may include inherent abnormalities of arterial structure. Extracranial dissection is associated with connective tissue disorders in adult stroke. Focal cerebral arteriopathy is a common syndrome where pathophysiology is unknown but may include intracranial dissection or transient cerebral arteriopathy.
Predicting Intracerebral Hemorrhage Growth With the Spot Sign
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Background and Purpose—Hematoma expansion after acute intracerebral hemorrhage is common and is associated with early deterioration and poor clinical outcome. The computed tomographic angiography (CTA) spot sign is a promising predictor of expansion; however, frequency and predictive values are variable across studies, possibly because of differences in onset-to-CTA time.
By Dar Dowlatshahi, Andrew Demchuk, Michael Hill, Richard I. Aviv, Max Wintermark, Yongjun Wang, Xingquan Zhao, Yilong Wang, Timolaos Rizos, Steven Greenberg, Javier Romero, Jonathan Rosand, Joshua Goldstein, H. Bart Brouwers, Lee-Anne Ufholz, Michael Reaume, Yasuo Murai, Takatoshi Sorimachi, Mitsunori Matsumae, Thorsten Steiner
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stroke.ahajournals.org
Risk of Recurrent Arterial Ischemic Stroke in Childhood
Background and Purpose—Published cohorts of children with arterial ischemic stroke (AIS) in the 1990s to early 2000s reported 5-year cumulative recurrence rates approaching 20%. Since then, utilization of antithrombotic agents for secondary stroke prevention in children has increased. We sought to determine rates and predictors of recurrent stroke in the current era.
Computed Tomography Perfusion in Acute Ischemic Stroke
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Computed tomography perfusion (CTP) is beyond prime time, ready for use to select patients with acute ischemic stroke for intravenous and endovascular reperfusion therapies in routine clinical practice. After 2 decades of fervent stroke research using advanced imaging and revascularization techniques, recent stroke trials astutely combined imaging and therapeutic expertise, likely the recipe for their resounding success.
By Mark Parsons, Michael Lev Verified, Max Wintermark, Magdy H. Selim, David S. Liebeskind, Carlos Molina
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stroke.ahajournals.org
Using Standard First-Pass Perfusion Computed Tomographic Data to Evaluate Collateral Flow in Acute Ischemic Stroke
Background and Purpose—The study aims to determine whether volume transfer constant (Ktrans) maps calculated from first-pass perfusion computed tomographic data are a biomarker of cerebral collateral circulation and predict the clinical outcome in acute ischemic stroke caused by proximal arterial occlusion. Methods—Consecutive patients with acute occlusion of the middle cerebral artery who received endovascular treatment were enrolled.
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