Intracranial aneurysms (IAs), detected in 2%-5% of the population, represent a major health care issue because ruptured aneurysms with resultant hemorrhage are associated with severe morbidity or mortality. With the increasing role of artificial intelligence (AI) in diagnostic radiology, we assessed the accuracy of a commercial AI tool (Aidoc) to detect intracranial aneurysms on head or head/neck CTA relative to fellowship-trained neuroradiologists.

Intracerebral hemorrhagic transformation (HT) is associated with poor outcome after reperfusion therapies in patients with stroke but is difficult to anticipate. Some patients with acute ischemic stroke (AIS) due to large vessel occlusion (LVO) can exhibit a lenticular heterogeneous signal on their baseline diffusion-weighted imaging that we called the dark diffusion sign (DDS). Our aim was to evaluate whether the presence of the DDS on pretreatment MRI of patients with LVO-AIS is associated with increased risk of HT after endovascular therapy (EVT).

Technical advancements in inner ear MRI promise improved diagnosis and management of Ménière disease (MD), but a key challenge in optimizing 3D-FLAIR protocols for inner ear imaging lies in selecting the optimal flip angle. This study evaluates the 3 most common flip angle parameters used in 3D-FLAIR imaging for MD through a prospective, head-to-head comparison of image quality at constant flip angle (CFA) 120, CFA 140, and variable flip angle (VFA) obtained 4 hours after IV administration of a single-dose gadolinium-based contrast agent.

Differentiating true progression from treatment-related changes in patients with glioblastoma (GBM) remains a major diagnostic challenge. Amino acid PET tracers such as [F18]-Fluciclovine provide biologically specific information, but clinical real-world validation across institutions is limited. We aimed to evaluate the clinical diagnostic performance of [F18]-Fluciclovine PET/MRI for distinguishing true progression from treatment-related change in patients with presumed GBM progression across 2 academic centers.

Subtraction iodine imaging (SII) and dual-energy CT-derived iodine imaging (DEII) have been proposed to enhance tumor delineation in head and neck cancers. However, the optimal energy for SII and the added diagnostic value of SII or DEII combined with conventional CT (CCT) remain uncertain. We aimed to determine the optimal energy for SII and to evaluate its incremental diagnostic benefits, as well as those of DEII.

Cerebral proliferative angiopathy (CPA) is a rare cerebrovascular malformation that differs fundamentally from classical arteriovenous malformations (AVMs). Unlike AVMs, CPA is characterized by a diffuse vascular network intermingled with normal brain parenchyma, absence of a compact nidus or dominant feeders, and trans-dural supply. We conducted a comprehensive review of 75 published studies comprising 153 patients to summarize the full imaging spectrum. It most commonly presents in adolescence or young adulthood, with a slight female predominance and generally involves the supratentorial brain, spanning multiple lobes.On CT and MRI, CPA typically demonstrates dispersed cortical flow voids and serpiginous enhancing vascular channels, with secondary findings like ischemia, cortical atrophy, calcifications, hemorrhage, and variable venous drainage patterns. Perfusion and metabolic imaging consistently reveal widespread hypoperfusion and impaired cerebrovascular reserve, supporting its ischemia-driven pathogenesis. Digital subtraction angiography shows absence of dominant feeders, proximal arterial stenoses, frequent trans-dural collaterals, rarely flow-related aneurysms and modest venous enlargement. It has a progressive nature, with risks of delayed infarction, hemorrhage, and neurological deficits.Multimodal imaging is essential for distinguishing this underrecognized yet clinically important entity from AVMs and other mimics, as management differs substantially. Standardized reporting frameworks may help refine diagnostic criteria and improve clinical outcomes.ABBREVIATIONS: CPA＝ Cerebral Proliferative Angiopathy; AVM＝ Arterio-venous malformation; VEGF＝ Vascular Endothelial Growth Factor.

Hajdu-Cheney Syndrome (HCS) is an exceedingly rare connective tissue disorder primarily manifested by skeletal abnormalities including acro-osteolysis, severe osseous demineralization, distinctive craniofacial/dental abnormalities and short stature. The syndrome is caused by gain-of-function mutations in the NOTCH2 gene, which disrupt bone remodeling and connective tissue integrity. While hearing loss is a known clinical manifestation of HCS, specific imaging findings have not been reported. We present the case of a 36-year-old male with HCS who underwent high-resolution CT of the temporal bones for evaluation of longstanding bilateral conductive hearing loss, which showed relatively symmetric, diffuse osseous demineralization of the temporal bones, with ossicular and otic capsule involvement.ABBREVIATIONS: HCS＝ Hajdu-Cheney Syndrome; CT = Computed Tomography; OI = Osteogenesis Imperfecta.

Detecting glioma recurrence is fundamental for clinical patient outcomes; however, conventional MRI (cMRI) techniques may be limited, leading to diagnostic uncertainty relevant for therapeutic intervention. This study aimed to evaluate whether a microvascular perfusion (µPerf) imaging technique based on spin-echo DSC perfusion MRI could support the early detection of glioma recurrence compared with cMRI by characterizing subtle vascular changes preceding macroscopic tumor growth.

Diagnostic imaging of the brain and spine in spontaneous intracranial hypotension (SIH) has evolved rapidly in the past several years, presenting challenges for practitioners seeking to stay current on the optimal methods for investigating and localizing spinal CSF leaks. We established a Guidelines Working Group with representation from experts in diagnostic imaging as well as external experts in the clinical management of SIH. Recommendations and statements addressing the selection and performance of diagnostic imaging in patients with known or suspected SIH were developed by using a modified Delphi process. The intent was to provide guidance across a variety of practice settings in North American health care systems to implement current best practices in the diagnostic evaluation of SIH.

Radiation therapy (RT), a primary treatment for head and neck cancer (HNC), increases the risk of radiation-induced carotid stenosis (RICS). This study examines the progression of carotid artery total occlusion (CATO) in patients with HNC after RT, focusing on low-density plaque (LDP) as a predictor, an aspect underexplored in prior research.

4D parathyroid CT is a multiphase protocol used in the setting of hyperparathyroidism to detect parathyroid adenomas, largely identified by their attenuation patterns relative to the thyroid and enlarged non-lymphoid soft tissue in the central compartment. This technique has previously been described utilizing traditional energy integrating detector-CT. We present our protocol using photon counting detector-CT as a means of using increased spatial and contrast resolution to help identify parathyroid adenomas.ABBREVIATIONS: PCD-CT= Photon Counting Detector-CT, EID-CT = Energy Integrating Detector-CT.

Neuroradiologists are constantly asked to adapt their practice and implement changes that align with the latest scientific evidence, such as new stroke imaging guidelines and innovative imaging sequences. Translation of evidence-based practices (EBPs) to clinical practice requires sustainable, replicable, locally relevant, equitable, and externally valid systems. Implementation science provides a conceptual framework for new practice adoption by identifying and addressing barriers. This brief narrative review defines implementation and de-implementation science, contrasting implementation science with quality improvement, and describes common implementation science frameworks with examples applicable to neuroradiology. The role of artificial intelligence in implementation science is also included.ABBREVIATIONS: AI = Artificial intelligence; CFIR = Consolidated Framework for Implementation Research; EBP = Evidence-based practice; EMR = Electronic medical record; RE-AIM = Reach Effectiveness Adoption Implementation Maintenance.

CT imaging of sub-millimeter middle ear prostheses-vital for post-surgery treatment-requires highspatial-resolution. This study evaluated the impact of spatial resolution for the visualization of prostheses using photon-countingdetector (PCD) CT, energy-integrating-detector (EID) CT, and EID-CT with attenuating comb filters.

Post dural puncture headache (PDPH) refractory to conservative measures can be clinically debilitating, and diagnostic evaluation with spinal imaging including CT myelography (CTM) may be performed to localize a CSF leak and guide treatment. The purpose of this study is to determine the diagnostic yield of CTM for detecting a CSF leak in patients with persistent PDPH.

Photon counting detector CT is a relatively new technology that is becoming increasingly prevalent. In recent years, photon counting CT has been shown to have benefits in numerous neuroradiologic clinical applications, including temporal bone imaging, detection of spinal CSF leaks, and CT angiography of the head, neck, and spine. New uses for photon counting detector CT continue to emerge, capitalizing on the high spatial resolution and other advantages of this technology to improve patient care. One potential application in the spine is the detection and localization of the artery of Adamkiewicz, which provides the dominant supply to the inferior portion of the anterior spinal artery. Localization of this artery is sometimes desired prior to surgeries requiring ligation of the foraminal neurovascular complex. Traditional energy integrating detector CT is useful but imperfect for detection of this relatively small and transiently opacifying vessel. The improved spatial resolution and spectral information obtained with photon counting CT may help improve detection of the artery of Adamkiewicz. In this clinical report, we outline a protocol for imaging the artery of Adamkiewicz with photon counting detector CT and describe a comparative analysis of three different reconstruction techniques in six consecutive patients who underwent this exam. We found that an intermediate sharp vascular kernel (Bv60) reconstructed with a low energy threshold outperformed other conditions, including a sharper kernel and a low keV virtual monoenergetic reconstruction.ABBREVIATIONS: AKA = artery of Adamkiewicz or great radiculomedullary artery; CNR = contrast-to-noise ratio; EID = energy integrating detector; PCD = photon counting detector QIR = quantum iterative reconstruction; T3D = low energy threshold; UHR = ultra-high resolution.

3D-segmentation and volumetry of vestibular schwannomas (VS) is a more accurate method to determine tumor growth on serial imaging, but manual annotation is time-consuming to implement in routine clinical practice. We evaluated and compared five deep learning-based segmentation models [nnUNet (base, ResEncL), U-Mamba, UNETR, and MedSAM] for 3D VS segmentation and volumetry, and examined robustness to acquisition heterogeneity and generalization on an external cohort MATERIALS AND METHODS: Our refined Internal dataset consisted of T1-contrast enhanced images, including 2,692 scans (n= 383 patients) for training and 277 scans (n=97 patients) for testing. Post model training and validation, performance was evaluated on both internal, as well as a publicly available external test set (n=241) using Dice similarity coefficient, Hausdorff distance, surfaceto-surface (S2S) distance and relative volume error (RVE). A sub-analysis of the model performance was also performed to evaluate the impact of tumor volumes and dataset heterogeneity.

Sickle cell disease (SCD) is the most common inherited hemoglobinopathy that can cause multiorgan injury due to anemia, sickling, vaso-occlusive injury and vasculopathy. Silent cerebral infarct (SCI) is a common imaging abnormality identified in the brain in SCD. In this study, we assessed the impact of SCI and hemoglobin levels on brain morphometry in children with SCD.

Clinical adoption of 7 Tesla (7T) MRI is increasing, yet the performance of commonly used hippocampal segmentation algorithms, none of which are trained on 7T data, remains largely uncharacterized. This study evaluates segmentation accuracy at 7T using a voxel intensity-based method and examines volumetric differences between paired 3T and 7T hippocampal segmentations.

Steal physiology, a marker of severe cerebrovascular impairment, is associated with cortical thinning, a morphological phenomenon seen in patients with chronic supply artery steno-occlusive disease. This link has been previously established only with a sudden "step" hypercapnic stimulus. The significance of steal patterns derived from a gradual "ramp" stimulus, and their association with structural brain injury, is unclear. We investigated how steal patterns derived from both step and ramp stimuli compare and relate to the severity of cortical thinning in patients with steno-occlusive disease.

The relationship between regional brain edema caused by anti-amyloid monoclonal antibodies (ARIA-E) and the degree of regional β-amyloid (Aβ) positron emission tomography (PET) signal reduction is unknown.

At many institutions, CT imaging is routinely performed among febrile neutropenic patients to identify fever sources. We examined the impact of surveillance sinus CT imaging results on the clinical management of febrile neutropenic patients with hematologic disorders undergoing chemotherapy or bone marrow transplant.