Delayed FLAIR-enhancement of benign notochordal remnant (ecchordosis physaliphora)

Ecchordosis physaliphora (EP) is a benign notochordal remnant most commonly encountered in the skull base. In opposition to typical cases of its invasive counterpart, that is, chordoma, EP does not show T1-enhancement. Now, we describe three patients with EP, discovered on delayed contrast-enhanced 3D FLAIR performed for endolymphatic hydrops imaging in suspected Menière's disease. All EP cases demonstrated intense, delayed FLAIR-enhancement of the notochordal remnant. The importance of this new observation of FLAIR-enhancement in EP is threefold: (1) it may increase the detection rate of EP, (2) FLAIR-enhancement in EP should not be mistaken for T1-enhancement in chordoma, and (3) it may open a new window for future imaging studies aiming to better differentiate EP from chordoma.