- Ultra-High-Field Targeted Imaging of Focal Cortical Dysplasia: The Intracortical Black Line Sign in Type IIb
Between 2013 and 2019, the authors performed a standardized 7T MR imaging protocol in patients with drug-resistant focal epilepsy. They focused on 12 patients in whom postsurgical histopathology revealed focal cortical dysplasia and explored the diagnostic yield of preoperative 7T versus 1.5/3T MR imaging and the correlations of imaging findings with histopathology. They observed clear abnormalities in 10/12 patients using 7T versus 9/12 revealed by 1.5/3T MR imaging. In patients with focal cortical dysplasia I, 7T MR imaging did not disclose morphologic abnormalities (n= 0/2). In patients with focal cortical dysplasia II, 7T uncovered morphologic signs that were not visible on clinical imaging in 1 patient with focal cortical dysplasia IIa (n= 1/4) and in all those with focal cortical dysplasia IIb (n= 6/6). T2*WI provided the highest added value. The authors conclude that the high sensitivity of 7T T2*-weighted images provides an additional tool in defining potential morphologic markers of high epileptogenicity within the dysplastic tissue of focal cortical dysplasia IIb and will likely help to more precisely plan epilepsy surgery.
- Cerebellar Heterotopias: Expanding the Phenotype of Cerebellar Dysgenesis in CHARGE Syndrome
The authors performed a retrospective, observational, cross-sectional study to assess the prevalence and characteristic features of cerebellar heterotopias in 35 patients with CHARGE syndrome with available brain MR imaging studies, as well as to evaluate additional features of cerebellar dysgenesis. Cerebellar heterotopias were identified in 27/35 (77%) patients with CHARGE, characteristic in both location and appearance. Additional features of cerebellar dysgenesis were present in 31/34 evaluable patients (91%), including inferior vermian hypoplasia (90%), anteromedial rotation of the inferior tonsils (90%), and disorganized foliation of the cerebellar hemispheres (74%) or superior vermis (16%). Patients with CHARGE syndrome have a high prevalence of characteristic cerebellar heterotopias.
- Comparison of CBF Measured with Combined Velocity-Selective Arterial Spin-Labeling and Pulsed Arterial Spin-Labeling to Blood Flow Patterns Assessed by Conventional Angiography in Pediatric Moyamoya
This study assesses the accuracy of combined velocity-selective arterial spin-labeling and traditional pulsed arterial spin-labeling CBF measurements in pediatric Moyamoya disease, with comparison with blood flow patterns on conventional angiography. Twenty-two neurologically stable pediatric patients with Moyamoya disease and 5 asymptomatic siblings without frank Moyamoya disease were imaged with velocity-selective arterial spin-labeling, pulsed arterial spin-labeling, and DSA (patients). Qualitatively, velocity-selective arterial spin-labeling perfusion maps reflect the DSA parenchymal phase, regardless of postinjection timing. Conversely, pulsed arterial spin-labeling maps reflect the DSA appearance at postinjection times closer to pulsed arterial spin-labeling postlabeling delay, regardless of vascular phase. ASPECTS comparison showed excellent agreement between arterial spin-labeling and DSA, suggesting velocity-selective arterial spin-labeling and pulsed arterial spin-labeling capture key perfusion and transit delay information, respectively. Velocity-selective arterial spin-labeling offers a powerful approach to image perfusion in pediatric Moyamoya disease due to transit delay insensitivity.
- Armed Kyphoplasty: An Indirect Central Canal Decompression Technique in Burst Fractures
This study assesses the results of armed kyphoplasty using vertebral body stents or the SpineJack in traumatic, osteoporotic, and neoplastic burst fractures with respect to vertebral body height restoration and correction of posterior wall retropulsion. The authors performed a retrospective assessment of 53 burst fractures with posterior wall retropulsion and no neurologic deficit in 51 consecutive patients treated with armed kyphoplasty. Posterior wall retropulsion and vertebral body height were measured on pre- and postprocedural CT. Armed kyphoplasty was performed as a stand-alone treatment in 43 patients, combined with posterior instrumentation in 8 and laminectomy in 4. Pre-armed kyphoplasty and post-armed kyphoplasty mean posterior wall retropulsion was 5.8 and 4.5 mm, respectively, and mean vertebral body height was 10.8 and 16.7 mm, respectively. They conclude that in the treatment of burst fractures with posterior wall retropulsion and no neurologic deficit, armed kyphoplastyyields fracture reduction, internal fixation, and indirect central canal decompression.
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