Purpose: Lateral cephalograms are conventionally used for landmark identification and cephalometric analysis, butexpose patients to ionizing radiation. Magnetic resonance imaging (MRI) is increasingly employed to evaluate various tissue types, with dental-dedicated MRI (ddMRI) emerging as a promising modality in clinical dentistry. High-quality MRI could offer a radiation-free alternative for orthodontic diagnosis and treatment planning. This pilot study aimed to evaluate the reliability of ddMRI for 2-dimensional (2D) orthodontic cephalometric landmark identification and annotation. Materials and Methods: Thirteen volunteers (7 men, 6 women; mean age 33±5.2 years) underwent ddMRI. Threeindependent raters identified 2D cephalometric landmarks and annotated their positions on the same ddMRI datasetstwice. The 3D Slicer application was used to identify key orthodontic cephalometric landmarks on multiplanar reconstruction images in the sagittal plane. Intra-rater and inter-rater reproducibility were assessed using intraclass correlation coefficients (ICCs), and reliability was evaluated by nominal differences in linear distance (mm) between annotated points. Results: Intra-rater ICCs ranged from 0.909 to 0.999, and inter-rater ICCs ranged from 0.988 to 0.999, indicating excellent intra- and inter-rater reliability. Bland-Altman plots were used to display mean differences (mm) and limits of agreement (±1.96 standard deviations) between annotations to assess potential biases. Conclusion ddMRI is a feasible imaging modality for 2D orthodontic landmark identification. Based on intra- andinter-rater reproducibility values, ddMRI demonstrates high reliability in identifying key orthodontic cephalometric landmarks, providing a radiation-free alternative for orthodontic diagnosis and treatment planning.

In-stent stenosis is a feared complication of flow diversion treatment for cerebral aneurysms. We present 2 cases of patients treated with pipeline flow diversion for unruptured cerebral aneurysms. Initial perioperative dual antiplatelet therapy (DAPT) consisted of standard aspirin plus clopidogrel. At 6-month follow-up cerebral angiography, the patients were noted to have developed significant in-stent stenosis (63% and 53%). The patients were treated with cilostazol and clopidogrel for at least 6 months. Subsequent angiography at 1-year post-treatment showed significant improvement of the in-stent stenosis from 63% to 34% and 53% to 21%. The role of cilostazol as treatment of intracranial in-stent stenosis has not been previously described. Cilostazol’s vasodilatory effect and suppression of vascular smooth muscle proliferation provides ideal benefits in this setting. Cilostazol plus clopidogrel may be a safe and effective alternative to standard DAPT for treatment of in-stent stenosis following flow diversion and warrants further consideration and investigation.