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Ultrahigh-field 7-T MRI offers superior resolution and contrast, which enable improved detection of subtle neuroanatomic abnormalities and disease-specific imaging biomarkers, with established clinical applications across a broad range of neurologic disorders.

Abstract BACKGROUND MYCN-amplified spinal ependymoma is a recently classified, rare, and aggressive subtype of spinal cord tumor, first defined by the 2021 WHO CNS5 classification. It predominantly affects adults in their 30s, with a slight female predominance; fewer than 50 cases have been reported worldwide. PURPOSE To characterize the molecular, imaging, and clinical features of MYCN-amplified spinal ependymomas and highlight their distinctiveness to aid in early diagnosis and therapeutic planning. METHODS We retrospectively reviewed institutional cases of MYCN-amplified spinal ependymomas and performed a literature-based analysis. Data on imaging, histopathology, molecular profiles, and clinical outcomes were examined to identify distinguishing diagnostic and prognostic features. RESULTS These tumors are typically present as intradural extramedullary masses, often in the thoracic spine, with intense contrast enhancement and prominent peritumoral edema. A lack of a clear cleavage plane with the spinal cord, early leptomeningeal, and intracranial dissemination are hallmark features. Rare reports of systemic metastases (e.g., to the humerus and paraspinal muscle) exist. Histologically, they are high-grade (WHO grade III) anaplastic ependymomas with a distinct DNA methylation profile. MYCN amplification—commonly seen in medulloblastomas and glioblastomas—drives tumor aggressiveness. Clinically, these tumors are refractory to standard treatments, with high rates of recurrence or progression within 1–2 years post-treatment. The median overall survival is approximately seven years, significantly poorer than conventional spinal ependymomas. CONCLUSION MYCN-amplified spinal ependymomas represent a rare but highly aggressive tumor subtype with unique imaging, histological, and molecular features. Early recognition is critical given rapid progression and poor prognosis. Investigational therapies targeting MYCN—such as HDAC, PARP, Aurora A-kinase, and BET inhibitors—hold promise for improved outcomes.

Diagnosis of motor neuron diseases and other corticospinal tractopathies requires a comprehensive approach that integrates clinical symptoms and laboratory findings with findings from conventional MRI and advanced neuroimaging.

ImportanceLip, oral, and pharyngeal cancers are important contributors to cancer burden worldwide, and a comprehensive evaluation of their burden globally, regionally, and nationally is crucial for effective policy planning.ObjectiveTo analyze the total and risk-attributable burden of lip and oral cavity cancer (LOC) and other pharyngeal cancer (OPC) for 204 countries and territories and by Socio-demographic Index (SDI) using 2019 Global Burden of Diseases, Injuries, and Risk Factors (GBD) Study estimates.Evidence ReviewThe incidence, mortality, and disability-adjusted life years (DALYs) due to LOC and OPC from 1990 to 2019 were estimated using GBD 2019 methods. The GBD 2019 comparative risk assessment framework was used to estimate the proportion of deaths and DALYs for LOC and OPC attributable to smoking, tobacco, and alcohol consumption in 2019.FindingsIn 2019, 370 000 (95% uncertainty interval [UI], 338 000-401 000) cases and 199 000 (95% UI, 181 000-217 000) deaths for LOC and 167 000 (95% UI, 153 000-180 000) cases and 114 000 (95% UI, 103 000-126 000) deaths for OPC were estimated to occur globally, contributing 5.5 million (95% UI, 5.0-6.0 million) and 3.2 million (95% UI, 2.9-3.6 million) DALYs, respectively. From 1990 to 2019, low-middle and low SDI regions consistently showed the highest age-standardized mortality rates due to LOC and OPC, while the high SDI strata exhibited age-standardized incidence rates decreasing for LOC and increasing for OPC. Globally in 2019, smoking had the greatest contribution to risk-attributable OPC deaths for both sexes (55.8% [95% UI, 49.2%-62.0%] of all OPC deaths in male individuals and 17.4% [95% UI, 13.8%-21.2%] of all OPC deaths in female individuals). Smoking and alcohol both contributed to substantial LOC deaths globally among male individuals (42.3% [95% UI, 35.2%-48.6%] and 40.2% [95% UI, 33.3%-46.8%] of all risk-attributable cancer deaths, respectively), while chewing tobacco contributed to the greatest attributable LOC deaths among female individuals (27.6% [95% UI, 21.5%-33.8%]), driven by high risk-attributable burden in South and Southeast Asia.Conclusions and RelevanceIn this systematic analysis, disparities in LOC and OPC burden existed across the SDI spectrum, and a considerable percentage of burden was attributable to tobacco and alcohol use. These estimates can contribute to an understanding of the distribution and disparities in LOC and OPC burden globally and support cancer control planning efforts.