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Purpose:To determine whether diffusion abnormalities can be observed in nonsymptomatic family members with a known causative Cu/Zn superoxide dismutase mutation (asymptomatic familial amyotrophic lateral sclerosis; AFALS ϩSOD1 ) in a family with autosomal dominant familial amyotrophic lateral sclerosis (ALS) using diffusion tensor imaging (DTI). Materials and Methods:A total of eight AFALS ϩSOD1 subjects (aged 17-43 years) were age-matched with 13 healthy controls (aged 19 -45 years) without SOD1 mutations. DTI was carried out on a 1.5T scanner. The diffusion index maps derived were then normalized spatially for voxelbased analysis. region of interest (ROI)-based analysis was also carried out.Results: Our voxel-based and ROI-based analysis showed that AFALS ϩSOD1 subjects have decreased fractional anisotropy (FA) (0.5401 vs. 0.5168, P Ͻ 0.05) and increased tensor trace (TT) (2.5854 ϫ 10 -3 mm 2 /second vs. 2.6226 ϫ 10 -3 mm 2 /second, P Ͻ 0.04) at the posterior limb of the internal capsule compared to the control subjects. Increased radial diffusivity (E (2,3)/2 ) was detected on both sides (right ϭ 0.5710 ϫ 10 -3 mm 2 /second vs. 0.5943 ϫ 10 -3 mm 2 /second, P Ͻ 0.05; left ϭ 0.5666 ϫ 10 -3 mm 2 / second vs. 0.5872 ϫ 10 -3 mm 2 /second, P Ͻ 0.05). No significant change in axial diffusivity (E 1 ) was detected. Conclusion:Abnormal diffusivity was found at the posterior limb of the internal capsule in AFALS ϩSOD1 subjects, hitherto unreported. Our results suggest that DTI may detect diffusion abnormalities in AFALS ϩSOD1 subjects before symptoms develop.

PurposeThe pipeline embolization device (PED) is a flow diverter that has shown promise in the treatment of intracranial aneurysms. Close to one-fifth of aneurysms, however, fail to occlude after PED placement. This study aims to identify anatomical features and clinicopathologic factors that may predispose failed aneurysm occlusion with the PED.Materials and MethodsWe retrospectively reviewed all anterior circulation unruptured saccular aneurysms treated with the PED in a single-center. The primary outcome measure was angiographic occlusion. Anatomical features and potential predictors, including gender, aneurysm location, size, height, aspect ratio, neck width, prior treatment and the number of PED, were studied using binary logistic regression.Results29 anterior circulation unruptured saccular aneurysms with a mean size of 6.99 mm treated with the PED in a single center were retrospectively studied. The overall occlusion rate was 79.3% after a mean follow-up of 9.2 months. Four aneurysms were related to the fetal-type posterior communicating artery (PComA), and all were refractory to flow diverter treatment. Female gender was significantly associated with a higher occlusion rate. We present the anatomical features and propose possible pathophysiological mechanisms of these PComA aneurysms that failed flow diverter treatment.ConclusionA PComA aneurysm with persistent fetal-type circulation appears to be particularly refractory to flow diverter treatment, especially when the aneurysm incorporates a significant portion of the PComA. Our experience suggested that flow diverting stents alone may not be the ideal treatment for this subgroup of aneurysms, and alternative modalities should be considered. Female patients were found to have a significantly higher rate of treatment success.