SUMMARY: The 3D edge-enhancing gradient-echo (EDGE) MR imaging sequence offers superior contrast-to-noise ratio in the detection of focal cortical dysplasia. EDGE could benefit from 7T MR imaging but also faces challenges such as image inhomogeneity and low acquisition efficiency. We propose an EDGE-MP2RAGE sequence that can provide both EDGE and T1-weighted contrast, simultaneously, improving data-acquisition efficiency. We demonstrate that with sequence optimization, EDGE images with sufficient uniformity and T1-weighted images with high gray-to-white matter contrast can be achieved.

The craniovertebral junction (CVJ) is a complex transition area between the skull and cervical spine. Pathologies such as chordoma, chondrosarcoma and aneurysmal bone cysts may be encountered in this anatomical area and may predispose individuals to joint instability. An adequate clinical and radiological assessment is mandatory to predict any postoperative instability and the need for fixation. There is no common consensus on the need for, timing and setting of craniovertebral fixation techniques after a craniovertebral oncological surgery. The aim of the present review is to summarize the anatomy, biomechanics and pathology of the craniovertebral junction and to describe the available surgical approaches to and considerations of joint instability after craniovertebral tumor resections. Although a one-size-fits-all approach cannot encompass the extremely challenging pathologies encountered in the CVJ area, including the possible mechanical instability that is a consequence of oncological resections, the optimal surgical strategy (anterior vs posterior vs posterolateral) tailored to the patient’s needs can be assessed preoperatively in many instances. Preserving the intrinsic and extrinsic ligaments, principally the transverse ligament, and the bony structures, namely the C1 anterior arch and occipital condyle, ensures spinal stability in most of the cases. Conversely, in situations that require the removal of those structures, or in cases where they are disrupted by the tumor, a thorough clinical and radiological assessment is needed to timely detect any instability and to plan a surgical stabilization procedure. We hope that this review will help shed light on the current evidence and pave the way for future studies on this topic.

Background Patients ≥80-year-old presenting with large-vessel occlusion treated with endovascular thrombectomy (EVT) have worst outcomes than younger individuals. Improved patient selection in this age range is warranted. We investigated the hypoperfusion-intensity-ratio (HIR) and its associations with baseline parameters and clinical outcomes in a cohort ≥80-year-old to assess whether it could an option in improving their selection for EVT. Methods We performed retrospective analysis of consecutive patients treated with EVT at our center between 2015 and 2019. Inclusion criteria were age ≥80-year-old, any baseline modified Rankin Scale (mRS), and anterior circulation occlusion. Demographic information, baseline characteristics, clinical data, and radiological imaging parameters were collected. HIR was dichotomized into favorable and unfavorable based on median value of the cohort. Good outcome was defined as mRS ≤2 at 90-days. Results We included 82 patients. HIR was significantly correlated with baseline ischemic core volume, NIHSS, and time-of-onset to groin puncture. Good outcome was achieved in 18.3% and mortality occurred in 34.1%. In patients with baseline mRS ≤2, the rate of good outcome was significantly higher in favorable vs unfavorable HIR (52.6% vs 20%, P=0.02). In shift-analysis, unfavorable HIR was significantly associated with downshift to mRS ≥3 (P=0.02). Regression analysis found lower baseline mRS (P=0.009), higher ASPECTS (P=0.02), complete recanalization (P=0.04), and lower HIR (P=0.02) to be associated with increased rate of good outcome. Hierarchical regression showed HIR to independently predict good outcome. Conclusions In our cohort, HIR was correlated with baseline parameters and predicted clinical outcomes. Future studies should investigate perfusion parameters such as HIR to improve the selection of elderly patients for EVT.

Calcifying pseudoneoplasms of the neuraxis (CAPNON) are very rare intracranial lesions with less than 50 cases reported in literature. These are non-neoplastic in etiology and despite having unique imaging characteristics, are often misdiagnosed as a neoplastic condition like meningioma, chordoma and gliomas. These do not have any predilection for any age, gender or intracranial location and can be seen in a wide range of age groups. Despite having an imaging overlap with neoplastic conditions, CAPNONs have classic histopathologic findings including chondromyxoid matrix, palisading spindle cells and calcific or ossific metaplasia. As more cases are being described in literature the imaging features are also being better defined. We discuss the clinical, imaging and histopathological findings of 2 cases of CAPNON mimicking posterior fossa meningioma and glial neoplasm.