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The authors sought to investigate whether co-occurrence of local anisotropic gradient orientations (COLLAGE) measurements from posttreatment gadolinium-contrast T1WI could distinguish varying extents of cerebral radiation necrosis and recurrent tumor classes in a lesion across primary and metastatic brain tumors. On 75 gadolinium-contrast T1WI studies obtained from patients with primary and metastatic brain tumors and nasopharyngeal carcinoma, the extent of cerebral radiation necrosis and recurrent tumor in every brain lesion was histopathologically defined by a neuropathologist as the following: 1) “pure” cerebral radiation necrosis; 2) “mixed” pathology with coexistence of cerebral radiation necrosis and recurrent tumors; 3) “predominant” (>80%) cerebral radiation necrosis; 4) predominant (>80%) recurrent tumor; and 5) pure tumor. COLLAGE features were extracted from the expert-annotated ROIs on MR imaging. COLLAGE features exhibited decreased skewness for patients with pure and predominant cerebral radiation necrosis and were statistically significantly different from those in patients with predominant recurrent tumors, which had highly skewed COLLAGE values.

Between May 2008 and July 2017, endovascular treatment of 1184 aneurysms in 827 patients was performed in a single institution. Twenty-four percent of these aneurysms were located at the MCA, and 150 unruptured MCA bifurcation aneurysms treated with coiling, stent-assistedcoiling, or endovascular flow diverter (WEB device) were identified for this retrospective data analysis. The procedure-associated good clinical outcome was 89.9%, and the mortality rate was 2.7%. Short-term follow-up good clinical outcome/mortality rates were 91.3%/0.7%. At discharge, 137 patients had an mRS of 0–2 (91.3%) and 13 had an mRS of 3–6 (8.7%). The authors conclude that regardless of the architecture of MCA bifurcation aneurysms, endovascular treatment can be performed with low morbidity/mortality rates.

Endovascular thrombectomy has proven efficacy for a wide range of patients with large-vessel occlusion stroke and in selected cases up to 24 hours from onset. While primary stroke centers have increased the proportion of patients withstroke receiving thrombolytic therapy, delays can be encountereduntil patients with LVO are identified and transferred from the primary stroke center to acomprehensive stroke center. Therefore, any extra steps need to be carefullyweighed. The use of CTA (especially multiphase) at the primary stroke center levelhas many advantages in expediting the transfer of appropriate patients to a comprehensive center.