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Available accessEditorialFirst published August, 2026pp. 403-405
Available accessReview articleFirst published August, 2026pp. 406-419Computed tomography perfusion (CTP) imaging plays a pivotal role in the early evaluation of patients presenting with acute ischemic stroke (AIS), particularly by identifying candidates for endovascular thrombectomy. Accurate interpretation of CTP requires a structured approach that integrates technical understanding, clinical judgment, and recognition of the modality’s limitations. This review was prompted by real clinical challenges faced by the senior author and aims to provide both a theoretical foundation and practical guidance for interpreting CTP. Key concepts are illustrated through real clinical scenarios and corresponding annotated images. In addition to reviewing current AHA/ASA guidelines, we discuss institutional best practices and highlight challenging clinical scenarios in which CTP can significantly influence treatment decisions. This article aims to equip clinicians with the knowledge and tools needed for consistent and effective use of CTP.
Available accessReview articleFirst published August, 2026pp. 420-427Medical errors are a significant cause of morbidity and mortality. Literature on common mechanisms to reduce radiological error are reviewed including shifting from general to subspecialized care, improving expertise, instituting shift volume and shift length limits, minimizing non-interpretive tasks, participating in focused educational and multidisciplinary conferences, and increasing practice size. Implementation of shift volume limits and full sub-specialization has the potential to significantly reduce radiologist error rates.
Available accessReview articleFirst published August, 2026pp. 428-437Endovascular removal of the Woven EndoBridge device (WEBectomy) is rarely reported but crucial for managing complications such as migration, compaction, and malposition, which may lead to recurrence and retreatment. This review aimed to assess treatment strategies, outcomes, and complications associated with WEBectomy.
We searched PubMed, Embase, and Web of Science databases from inception to January 14,
Eight studies with 16 patients (range age 30–89; 50% male) with 16 aneurysms were included. The basilar artery was the most common site in 25% (4/16) of the cases, and 50% (7/14) of the aneurysms were ruptured. Migration was the most frequent complication (11/16, 69%), followed by protrusion (4/16, 25%) and malposition (1/16, 6%) that required the removal of WEB. The Amplatz Goose Neck Microsnare was the most commonly used retrieval device (12/16, 75%), with no reported failures or major complications. Retreatment involved a new WEB in 50% (8/16) and coiling techniques in 31% (5/16). Among nine patients with follow-up imaging, most showed complete occlusion (67%, 6/9). Functional outcomes were favorable in 83% (4/6) (mRS 0–1).
Reported cases show that WEBectomy can be successfully performed in selected situations, allowing tailored retreatment planning. However, due to the small number of cases and limited follow-up, no definitive conclusions about safety or efficacy can be drawn. This review provides a concise synthesis of current management strategies for this rare complication.
Available accessReview articleFirst published August, 2026pp. 438-451The susceptibility vessel sign (SVS) on MRI has been linked to functional outcomes and reperfusion success after endovascular treatment (EVT), suggesting its potential as a prognostic marker. This updated systematic review and meta-analysis aimed to evaluate the prognostic and etiological significance of SVS in acute ischemic stroke (AIS).
We conducted a systematic search of PubMed, Embase, and Cochrane in May 2025. Eligible studies included post-hoc analyses of randomized controlled trials (RCTs) and observational studies of AIS patients treated with EVT and/or intravenous thrombolysis (IVT). Pooled risk ratios (RRs) with 95% confidence intervals (CIs) were calculated using a random-effects model. Primary outcome was successful reperfusion (mTICI 2b-3). Secondary outcomes included functional independence (modified Rankin Scale [mRS] score 0–2), mortality, stroke etiology, and time metrics.
Eighteen studies (
Although SVS+ did not predict reperfusion, it was associated with better functional outcomes in Western populations, particularly in cardioembolic stroke, and lower mortality, thereby reinforcing its prognostic value. MRI protocols did not delay treatment, but high heterogeneity limits certainty, highlighting the need for prospective studies.
Available accessOtherFirst published August, 2026pp. 452-460Bourgeoning vehicular accidents is leading to a rise in the traumatic brachial plexus injuries (TBPIs). Brachial plexus is a cardinal neural plexus catering to the sensory-motor function of the upper limb. Thus, prompt diagnosis and early management are must in case of TBPIs. Although no single modality is a universal gold standard across the full spectrum of TBPIs, Magnetic resonance imaging (MRI) forms the corner stone of imaging evaluation. Even with excellent resolution, clinching the diagnosis is an uphill task, as already complicated anatomy, becomes scrambled following trauma. Imaging plays a crucial role in management, as it not only diagnose TBPIs, but also accurately identify the site of injury and stratify it. Grading of TBPIs have bearing of management decisions and an accurate stratification, leads to significant reduction in morbidity. Modified Sunderland Classification is widespread accepted classification which can be correlated on MRI. Through this manuscript, the author has tried to simplify this correlation and provide an image guide for imagers along with a table summarizing the important take home points at last.
Available accessResearch articleFirst published August, 2026pp. 461-484
, Ali Enes Aldur, Rahsan GocmenLeptomeningeal diseases represent a diverse group of pathological conditions affecting the pia and arachnoid mater, encompassing a wide spectrum of infective-inflammatory, neoplastic, and vascular etiologies. Early and accurate diagnosis is crucial due to the often severe clinical implications and overlapping imaging features. This review provides a comprehensive overview of commonly encountered and some rare leptomeningeal diseases, emphasizing their pathophysiology, clinical manifestations, and distinctive imaging characteristics. We categorize these conditions based on their underlying etiology and highlight key differentiating features to facilitate accurate radiological interpretation. By integrating imaging findings with clinical background, this review aims to support neuroradiologists and clinicians in the effective evaluation and differential diagnosis of leptomeningeal diseases. Enhanced understanding of these pathologies will aid earlier diagnosis and optimal management, ultimately leading to better patient outcomes.
Available accessResearch articleFirst published August, 2026pp. 485-491, Philipp von Gottberg, Ali Khanafer , [...]Carotid artery stenting (CAS) is an established alternative to carotid endarterectomy for the treatment of atherosclerotic carotid stenosis. However, periprocedural ischemic stroke remains a concern, partly influenced by device selection and procedural technique. The optimal dilatation strategy, particularly the role of pre- and post-stenting balloon dilatation, remains debated. This study aimed to evaluate the safety and efficacy of CAS using pre-stenting dilatation alone compared with combined pre- and post-stenting dilatation.
A retrospective analysis was conducted of 1248 CAS procedures performed in 1158 patients at a single neurovascular center (May 2009–December 2020). Baseline characteristics, procedural details, and outcomes were compared between cases with pre-stenting dilatation alone and those with additional post-stenting dilatation. The primary endpoint was the 30-day composite stroke rate; secondary outcomes included periprocedural adverse events and long-term in-stent restenosis (ISRS > 50%).
Pre-stenting dilatation was performed in all cases; additional post-stenting dilatation was used in 150 procedures (12%). The 30-day composite stroke rate was 2.6%, significantly lower in the pre-dilatation-alone group than in the combined group (2.1% vs. 7.2%;
In this large single-center experience, CAS using pre-stenting dilatation alone was associated with a lower periprocedural stroke rate and comparable long-term patency. These findings support a simplified procedural approach that may reduce embolic risk without compromising efficacy.
Available accessResearch articleFirst published August, 2026pp. 492-500Differentiating cerebellopontine meningioma (CPM) from schwannoma (CPS) can be challenging. In this location, schwannomas alter the composition of the perilymphatic fluid differently from meningiomas, which has repercussions on magnetic resonance imaging. This study aims to distinguish between these tumors based on the labyrinthine fluid signal on 3D-CISS.
Patients with histologically confirmed CPM and CPS were selected. Analyses were performed considering visual signal intensity from the vestibule and cochlea, and the signal ratios between the vestibules (aV/uV) and the cochleae (aC/uC) on affected and unaffected sides. The signal intensity ratio between vestibule and cerebellum (aV/aCH), vestibule and cerebrospinal fluid (aV/aCSF), and cochlea and cerebrospinal fluid (aC/aCSF), on affected sides, as well as the vestibule and cerebellum ratio between affected and unaffected sides ([aV/aCH]: [uV/uCH]), were also compared.
Statistically significant differences were demonstrated for visual signal reduction (
The visual reduction of cochlear signal and the aC/uC and aC/aCSF ratios proved to be the most effective parameters for distinguishing CPM from CPS when the labyrinthine fluid is utilized.
Open accessResearch articleFirst published August, 2026pp. 501-512, Jackson D Hamilton, Maria A Gubbiotti , [...]High-grade astrocytoma with piloid features (HGAP) is a recently described IDH-wildtype tumor with limited literature describing its imaging features. We present our institution’s experience and the largest imaging-focused cohort of HGAP reported to date, offering a comprehensive analysis of MRI features of seventeen intracranial and one spinal HGAP, while introducing novel imaging features that have not been previously described. These include focal areas of diffusion restriction, surrounding spiculated, finger-like enhancement and increased perfusion metrics. Additionally, we highlight imaging features of HGAP arising in patients with Neurofibromatosis Type 1, such as intraventricular tumor spread, unusual temporal lobe location and multifocal presentation.
Available accessResearch articleFirst published August, 2026pp. 513-522, Daksh Mehta, Archya Dasgupta , [...]Interpretation of imaging findings after radiation can be challenging in patients with high-grade glioma. Appearance of contrast-enhancing lesions during follow-up imaging poses difficulty in differentiating true progression from treatment-related changes. In the current study, we report patterns and clinical outcomes of radiation-induced subependymal enhancement.
Patients with histopathological diagnosis of HGG developing radiation-induced contrast enhancement in the subependymal region were considered in the retrospective study. The subependymal enhancement was required to be in the high-dose region of radiotherapy. Patients underwent multiparametric magnetic resonance imaging (MRI), which included T1-contrast, T2-weighted, perfusion, and spectroscopy. Confirmation of radiation changes rather than disease progression was decided based on regression or stability of concerned findings on follow-up imaging.
Thirty-four patients were included in the analysis. The median time from radiotherapy to onset of subependymal enhancement was 15 months. The enhancement pattern was feathery, nodular, and linear in 53%, 35%, and 3% of patients, respectively. A T2-hyperintense signal with a hypointense rim was seen in 74% of patients. Majority of these lesions were isoperfused (26%) or hypoperfused (47%). The median radiological follow-up after onset of subependymal enhancement was 7 months (range 1–61 months). At final follow-up, complete resolution, partial regression, and stable findings of the concerned enhancement were seen in 18%, 38%, and 44%, respectively.
Subependymal enhancement can be seen following radiation, which should be considered during the evaluation of follow-up imaging. Multiparametric MRI with specific contrast patterns, T2-weighted findings, and perfusion imaging can help identify radiation-induced enhancement.
Open accessResearch articleFirst published August, 2026pp. 523-531Available accessCase reportFirst published August, 2026pp. 532-535, Fumiyuki Yamasaki, Ushio Yonezawa , [...]Diagnosing Rasmussen encephalitis presents a significant challenge when cortical atrophy is absent on MRI. We present a case of Rasmussen encephalitis in a 13-year-old boy with lack of atrophy and imaging features mimicking glioma, including increased 11C-methionine (MET)-PET uptake, which led to diagnostic uncertainty. The patient had been previously diagnosed with chronic autoimmune encephalitis and epilepsy for about 6 years prior. Initial MRI revealed an FLAIR hyperintensity in the left frontal lobe and basal ganglia region without cortical atrophy, which remained stable for several years. However, 1 year after the last follow-up, the lesion demonstrated progressive enlargement. MRS demonstrated an increased choline/NAA ratio, increased CBF on ASL, and increased accumulation on MET-PET primarily in the gray matter adjacent to the FLAIR hyperintense lesion. Because these imaging characteristics could not rule out the possibility of glioma, we decided to perform open biopsy via a small craniotomy to establish definitive diagnosis while minimizing the burden on the patient. The pathological examination revealed cortical thickening, increased astrogliosis, and CD3+ and CD8+ T-cells infiltration. A final diagnosis of Rasmussen encephalitis was established, with follow-up MRI demonstrating a gradual reduction in the lesion signal intensity. The current case highlights the difficulties of distinguishing Rasmussen encephalitis from glioma in the absence of cortical atrophy, as they share similar MRI features and MET-PET uptake patterns. In such cases, a minimally invasive biopsy is recommended to establish a definitive diagnosis and reduce patient burden.