Laser interstitial thermal therapy for treatment of a recurrent skull base chordoma: illustrative case.

Background: The authors applied laser interstitial thermal therapy (LITT) to a recurrent skull base chordoma, which has not been previously described.

Observations: A 63-year-old man was initially diagnosed with an 8-cm destructive clival chordoma, which was aggressively resected endoscopically but recurred despite multiple operations, proton radiation therapy, and chemotherapy. The patient underwent uncomplicated LITT for a subtemporal mass, which palliated the tumor for 10 months.

State of Practice on Transcranial MR-Guided Focused Ultrasound: A Report from the ASNR Standards and Guidelines Committee and ACR Commission on Neuroradiology Workgroup.

Transcranial focused ultrasound (FUS) is a versatile, MR-guided, incisionless intervention with diagnostic and therapeutic applications for neurologic and psychiatric diseases. It is currently FDA-approved as a thermoablative treatment of essential tremor and Parkinson disease. However, other applications of FUS including BBB opening for diagnostic and therapeutic applications, sonodynamic therapy, histotripsy, and low-intensity focused ultrasound neuromodulation are all in clinical trials.

A Standardized Approach to MRI-Guided Stereotactic Laser Corpus Callosotomy: Technical Description and Pediatric Case Series.

Background And Objectives: Corpus callosotomy is an effective procedure approach for treating medication-resistant drop seizures, which pose a significant challenge in patients with epilepsy. Laser interstitial thermal therapy offers an alternative to open surgery for performing corpus callosotomy that may limit approach-related comorbidities. Practices vary regarding the number of laser filaments used and staging; outcome data for pediatric patients remain relatively limited.

CellKine clinical trial: first report from a phase 1 trial of allogeneic bone marrow-derived mesenchymal stem cells in subjects with painful lumbar facet joint arthropathy.

Background: Lumbar facet joint arthropathy (LFJA) is a major cause of low back pain (LBP), with current treatments offering limited long-term benefits. Bone marrow-derived mesenchymal stem cells (BM-MSCs) show promise due to their immunomodulatory and trophic effects, potentially addressing underlying degenerative processes in LFJA.

Objectives: This initial report describes the outcomes of the first treated patient in an ongoing mutidisciplinary phase 1 clinical trial evaluating the safety and feasibility of intra-articular allogeneic BM-MSCs for painful LFJA.

High-Resolution Head CTA: A Prospective Patient Study Comparing Image Quality of Photon-Counting Detector CT and Energy-Integrating Detector CT.

Background And Purpose: Photon-counting detector CT (PCD-CT) is now clinically available and offers ultra-high-resolution (UHR) imaging. Our purpose was to prospectively evaluate the relative image quality and impact on diagnostic confidence of head CTA images acquired by using a PCD-CT compared with an energy-integrating detector CT (EID-CT).

Materials And Methods: Adult patients undergoing head CTA on EID-CT also underwent a PCD-CT research examination.

Imaging Findings in Giant Cell Arteritis: Don't Turn a Blind Eye to the Obvious!

Giant cell arteritis (GCA) is the most common primary large vessel systemic vasculitis in the Western World. Even though the involvement of scalp and intracranial vessels has received much attention in the neuroradiology literature, GCA, being a systemic vasculitis, can involve multiple other larger vessels including the aorta and its major head and neck branches. Herein, the authors present a pictorial review of the various cranial, extracranial, and orbital manifestations of GCA.

High yield clinical applications for photon counting CT in neurovascular imaging.

Photon-counting CT (PCCT) uses a novel X-ray detection mechanism that confers many advantages over that used in traditional energy integrating CT. As PCCT becomes more available, it is important to thoroughly understand its benefits and highest yield areas for improvements in diagnosis of various diseases. Based on our early experience, we have identified several areas of neurovascular imaging in which PCCT shows promise.

MRI-guided focused ultrasound ablation of painful lumbar facet joints: a retrospective assessment of safety and tolerability in human subjects.

Objective: To evaluate the safety and tolerability of MRI-guided focused ultrasound (MRgFUS) for the treatment of facet joint-mediated pain in human subjects for whom conventional treatment had failed. Secondarily, to evaluate effectiveness of the procedure.

Methods: Consecutive patients who underwent MRgFUS at our institution were retrospectively identified.

Laser Interstitial Thermal Therapy for Epilepsy.

Laser interstitial thermal therapy is an important new technique with a diverse use in epilepsy. This article gives an up-to-date evaluation of the current use of the technique within epilepsy, as well as provides some guidance to novice users appropriate clinical cases for its use.

Safety profile and technical success rate of computed tomography-guided atlanto-axial lateral articulation injections.

Objective: To describe the technique, safety profile, and outcome of computed tomography (CT)-guided atlanto-axial lateral articulation injections performed at our institution.

Methods: Consecutive cases of all CT-guided atlanto-axial injections performed from January 2017 to April 2022 at our institution were searched in the electronic medical records. Patient charts were reviewed for demographics, characterization of pain, potential altered anatomy, pain level before and immediately after the procedure, procedure technique, complications, and follow-up outcomes, if available.

Vessel wall imaging features of Moyamoya disease in a North American population: patterns of negative remodelling, contrast enhancement, wall thickening, and stenosis.

Background: This study characterized vessel wall imaging (VWI) features of Moyamoya disease (MMD) in a predominantly adult population at a North American center.

Methods: Consecutive patients with VWI were included. Twelve arterial segments were analyzed for wall thickening, degree and pattern of contrast enhancement, and remodeling.

Spontaneous intracranial hypotension: updates from diagnosis to treatment.

Spontaneous intracranial hypotension (SIH) is caused by spinal cerebrospinal fluid (CSF) leaks, which result in continued loss of CSF volume and multiple debilitating clinical manifestations. The estimated annual incidence of SIH is 5/100,000. Diagnostic methods have evolved in recent years due to improved understanding of pathophysiology and implementation of advanced myelographic techniques.

Vessel wall MR imaging of aortic arch, cervical carotid and intracranial arteries in patients with embolic stroke of undetermined source: A narrative review.

Despite advancements in multi-modal imaging techniques, a substantial portion of ischemic stroke patients today remain without a diagnosed etiology after conventional workup. Based on existing diagnostic criteria, these ischemic stroke patients are subcategorized into having cryptogenic stroke (CS) or embolic stroke of undetermined source (ESUS). There is growing evidence that in these patients, non-cardiogenic embolic sources, in particular non-stenosing atherosclerotic plaque, may have significant contributory roles in their ischemic strokes.

Value of dual energy CT in post resuscitation coma. Differentiating contrast retention and ischemic brain parenchyma.

Applications of dual-energy computed tomography and virtual non-contrast technique in neuroimaging are still emerging. While the role of DECT in differentiating parenchymal hemorrhage and contrast media after mechanical revascularization is well recognized, the value of DECT in evaluation of brain ischemia in post resuscitation patients who have received intravenous (IV) iodinated contrast is not well documented. We present a challenging case where DECT helped explain hyperattenuation in cortical grey matter and deep grey nuclei as well as cerebellar hemispheres in a comatose patient post cardiac arrest following massive pulmonary embolism.

Comparison of the impact of skull density ratio with alternative skull metrics on magnetic resonance-guided focused ultrasound thalamotomy for tremor.

Objective: One of the key metrics that is used to predict the likelihood of success of MR-guided focused ultrasound (MRgFUS) thalamotomy is the overall calvarial skull density ratio (SDR). However, this measure does not fully predict the sonication parameters that would be required or the technical success rates. The authors aimed to assess other skull characteristics that may also contribute to technical success.

Outcomes and Principles of Patient Selection for Laser Interstitial Thermal Therapy for Metastatic Brain Tumor Management: A Multisite Institutional Case Series.

Background: Laser interstitial thermal therapy (LITT) is an emerging treatment modality for both primary brain tumors and metastases. We report initial outcomes after LITT for metastatic brain tumors across 3 sites at our institution and discuss potential strategies for optimal patient selection and outcomes.

Methods: International Classification of Diseases, Ninth Revision and Tenth Revision codes were used to identify patients with malignant brain tumors treated via LITT across all 3 Mayo Clinic sites with at least 6 months follow-up.

Successful fusion versus pseudarthrosis after spinal instrumentation: a comprehensive imaging review.

Purpose: Following spinal instrumentation and fusion, differentiating between successful arthrodesis and pseudoarthrosis on imaging can be challenging. Interpretation of such examinations requires understanding both the expected evolution of postoperative findings and the subtle indicators of pseudoarthrosis across multiple imaging modalities. Due to this level of intricacy, many clinicians lack familiarity with the subject beyond the more rudimentary concepts.

Journal Selection Primer for Neuroradiology Researchers.

Junior Neuroradiology investigators face a rapidly expanding universe of potential journals for manuscript submission. Each journal possesses many unique features, including scope/breadth of research focus, willingness to accept specific types of articles (for example, Review Articles, or Case Reports), status of indexing on major academic indices, scholarly relevance (usually defined as Impact Factor) and access type (Open Access, subscription, or Hybrid Access). An uninformed choice of target journal can burden not only Editors and Reviewers but also increase the effort and frustration level of relatively inexperienced investigators and ultimately result in a worthy manuscript not getting published.

Lateral decubitus dynamic CT myelography for fast cerebrospinal fluid leak localization.

Dynamic CT myelography is used to precisely localize fast spinal CSF leaks. The procedure is most commonly performed in the prone position, which successfully localizes most fast ventral leaks. We have recently encountered a small subset of patients in whom prone dynamic CT myelography is unsuccessful in localizing leaks.

Injection into the Space of Okada During Transforaminal Epidural Steroid Injections.

Objective: Ensuring medication delivery to the epidural space is crucial for effective transforaminal epidural steroid injections. Epidural needle placement is determined by injecting a small amount of contrast at the final needle position. The purpose of this study is to illustrate the appearance of contrast flow in the retrodural retroligamentous space of Okada during computed tomography- and fluoroscopy-guided cervical and lumbar transforaminal epidural steroid injections.

Hyperostosis in Combination With Low Skull Density Ratio: A Potential Contraindication for Magnetic Resonance Imaging-Guided Focused Ultrasound Thalamotomy.

Since its approval in treating a number of movement disorders, magnetic resonance imaging-guided focused ultrasound (MRgFUS) has been adopted rapidly as one of the standard treatment modalities internationally. However, the efficiency of the energy delivered by the ultrasonic waves is largely determined by the highly variable bone morphology and density characteristics of the skull. One of the widely accepted indices used to facilitate patient selection is the skull density ratio (SDR).