bluuebunny/crossref_metadata_2025 huggingface dataset:
Ultrasonography and MR Imaging in Progressive Supranuclear Palsy
Authors: Liboni W. , Pignatta P. , Salzedo E. , Giordano S. , Molinari F.
Published: April 2015

Progressive supranuclear palsy (PSP) also known as Steele, Richardson and Olszewski disorder is a neurodegenerative brain disease that has no known cause, treatment or cure. PSP has no known geographical, occupational or racial preference and affects brain cells that control walking, balance, mobility, vision, speech and swallowing. Symptoms begin on average in the early 60s, but may start as early as in the 40s: a good history and physical examination support the clinical diagnosis and latency of each feature makes us suspect a probable PSP, an atypical Parkinsonism. The diagnosis of a large number of cases of PSP is missed or delayed: 75% of the patients are never clinically diagnosed by neurologist and in most cases the median interval between onset and diagnosis is three years. Notwithstanding such differences in clinical presentation, there remains an overlap in symptoms making the differential diagnosis between such neurodegenerative disorders challenging. A few imaging techniques developed to evaluate brain anatomy and function are used extensively to improve the diagnostic accuracy of different forms of Parkinsonism. Noninvasive and safe methods can now document brain structures. Transcranial sonography (TCS) is a very low cost tool to assess the basal ganglia and mesencephalic echogenicity. Conventional magnetic resonance imaging (MRI) is a valuable tool to exclude secondary Parkinsonism. Our purpose is to define characteristic objectively measured imaging markers that point out normal biological processes, and pathogenic processes in PSP. Such markers should be sufficiently sensitive and specific to show the underlying biological disease and the pharmacological responses to therapy.
Posterior Reversible Encephalopathy Syndrome with Obstructive Hydrocephalus
Authors: Wirojtananugoon C. , Laothamatas J.
Published: April 2015

We describe an unusual presentation of posterior reversible encephalopathy syndrome (PRES) with predominant posterior fossa edema, causing ascending transtentorial herniation, tonsillar herniation, and obstructive hydrocephalus. MR imaging with additional MR spectroscopy and MR perfusion helped discriminate PRES from infiltrative tumor, and supported the pathogenesis of hydrostatic edema. Infusion of an antihypertensive drug was promptly administered. Diversion of cerebrospinal fluid by ventriculostomy was subsequently performed. However, the patient developed thalamic hemorrhage and secondary intraventricular hemorrhage with contralateral hemiparesis. Awareness of this rare cause of obstructive hydrocephalus with aggressive treatment of high blood pressure may help obviate the need of ventriculostomy and may prevent the hemorrhagic complication.
Five-Year Longitudinal MRI Follow-up and 1H Single Voxel MRS in 14 Patients with Gliomatosis Treated with Temodal, Radiotherapy and Antiangiogenic Therapy
Authors: Constans J.M. , Collet S. , Kauffmann F. , Hossu G. , Dou W. , Ruan S. , Rioult F. , Derlon J.M. , Lechapt-Zalcmann E. , Chapon F. , Valable S. , Théron J. , Guillamo J.S. , Courthéoux P.
Published: April 2015

Gliomatosis cerebri (GC) is a challenging tumor, considered to have a poor prognosis and poor response to treatments. The purpose of this study is to better understand glial tumor metabolism and post chemotherapy, radiotherapy and antiangiogenic variations in a longitudinal study to determine cerebral variation in MRS area, amplitude, and ratios of metabolites and spectral profiles during a five year longitudinal follow-up in 14 patients with gliomatosis without initial hyperperfusion and treated with chemotherapy (Temozolomide (Temodal®)), radiotherapy and subsequent antiangiogenic therapy. The study also aimed to detect changes in infiltration, proliferation, lipids or glycolytic metabolism, as these changes could be monitored longitudinally in humans with glial brain tumors (low and high grade) after therapy, using conventional magnetic resonance imaging (MRI), spectroscopy (MRS) and MR perfusion. Most patients had first initial clinical and MRS improvement and stable MRI. After 12 to 24 chemotherapy treatment cycles MRS usually showed an increase in the Cho/Cr ratio (proliferation) and sometimes contrast enhancements. Later, the patients showed clinical deterioration and radiotherapy was started. There was an improvement with radiotherapy that lasted nine to 18 months. This was followed by a worsening that led to try antiangiogenic therapy. Later in the evolution for three patients with hyperperfusion this symptom disappeared, but proliferation, infiltration and glycolytic metabolism remained at a high level. Spectroscopic and metabolic changes often occur well before clinical deterioration and sometimes before improvement. Therefore, MRS could be more sensitive and could detect changes earlier than MRI and is sometimes predictive. Despite the difficulty, the variability and unknown factors, these repeated measurements give us a better insight into the nature of the different processes, tumor progression and could lead to better understanding of therapeutic response.
Congenital CNS Tumors Diagnosed on Prenatal MRI
Authors: Bekiesinska-Figatowska M. , Jurkiewicz E. , Duczkowski M. , Duczkowska A. , Romaniuk-Doroszewska A. , Bragoszewska H. , Ceran A.
Published: April 2015

Congenital tumors form a unique group among pediatric neoplasms. They are different from other tumor groups in this population not only due to the onset time but also to their histopathology, anatomic location, biologic behavior and prognosis. The development of fetal MRI allowed early diagnosis of these tumors. Three fetuses with congenital central nervous system (CNS) tumors were diagnosed prenatally and confirmed with histopathology. Prenatal ultrasonography (US) and magnetic resonance imaging (MRI) were performed. After birth MRI or computed tomography (CT) were carried out. In one case a large intra-axial brain tumor was diagnosed with solid, cystic and hemorrhagic elements. After surgery the tumor turned out to be choroid plexus carcinoma. In the second case craniopharyngioma arising from the suprasellar region was diagnosed on the basis of prenatal MRI and confirmed. In the third case extra-axial meningioma-like tumor was visualized on fetal MRI. After surgery it turned out to be desmoplastic infantile astrocytoma. Intracranial teratoma, the most typical CNS congenital tumor, was not diagnosed in our material. Our cases were rarely encountered neoplasms: choroid plexus carcinoma, craniopharyngioma and desmoplastic infantile astrocytoma. The examinations were repeated after birth and did not add significant information. In utero diagnostics is easier and safer than postnatal imaging of the sick baby that may require life-support equipment, and provides information of equal value.
Hippocampal MR Volumetric Studies in Paediatric Patients with Epilepsy and Normal Controls
Authors: Salmah J. Win Mar , Noorfizura A. , Shafie A. Mohd , Helmy A. , Salmi A.R. , Naing L.
Published: April 2015

The aim of this study was to determine and compare the hippocampal volume in children with epilepsy and in children in a control group and to compare the mean of right and left hippocampal volume in control subjects. This study was carried out at University Sains Malaysia (USM) from January 2008 to June 2009. This is a cross sectional study of 40 children with epilepsy and 40 children in a control volunteer group. Serial MRI of brain and temporal lobe were performed using a Signa Horizon LX 1.0 Tesla system. Oblique coronal sections perpendicular to the axis of temporal lobe were done with 4 mm slice thickness and 1 mm gap. T1, T2, FLAIR and SPGR series were done. The whole hippocampal volume was measured. Volumetry was done manually by using Osirix workstation (v 3.5.1–64 bit). All slices were measured three times and the average volume was taken. Data were analyzed by paired t test and independent t test for univariate data. The mean hippocampal volume in the control group was 2.81 cm3 (SD=0.38) and 2.65 cm3 (SD=0.41) for right and left hippocampus respectively. The mean hippocampal volume in epilepsy patients was 2.47 cm3 (SD=0.52) and 2.39 cm3 (SD=0.44) for right and left respectively. The hippocampal volume in epileptic children was significantly smaller than normal control children in average volume (p=0.001) and both right (p=0.002) and left (p=0.007) individually. In the control group, the right hippocampus volume was much greater than the left (p<0.001). The data of this study provide a useful reference for the study of hippocampal volume in the Malay paediatric population. It is useful in doubtful cases to determine which side is affected and also serves as part of the study to establish the whole age-related hippocampal growth.
MR Myelography in Patients with Lumbosacral Radicular Pain: Diagnostic Value and Technique
Authors: Wilmink J.T.
Published: April 2015

Lumbosacral radicular sciatic pain can frequently be the result of nerve root compression, for instance by a herniated lumbar disc. Spinal imaging may however reveal disc herniations which are not associated with sciatica, even present in individuals without any complaints. In addition, sciatic pain may be the result of spinal or even paraspinal pathology without any involvement of the nerve root: so-called “pseudo” radicular pain. It is important therefore in clinical diagnostic imaging to match the potential cause of sciatica (e.g. a disc herniation) as closely as possible with its effect (actual compression of the nerve root). Assessing nerve root compression is not always easy on standard MR images. MR myelography provides a high-resolution image of the normal or compressed nerve root in a very brief acquisition time which enables the MRM acquisition to be added on to the standard examination. The MRM images provide valuable supplementary information but cannot replace the standard T1- and T2-weighted sagittal and axial images.
Evaluating Marrow Signal Intensity: Comparison of T1 FLAIR and T1 FSE Images
Authors: Destian S. , Allmendinger A.
Published: April 2015

The purpose of the study was to determine whether there is a difference in the appearance of the marrow signal intensity on T1 FLAIR and T1 FSE images, and if so, whether the difference is related to age. T1 FLAIR and T1 FSE sequences, obtained prospectively in 93 patients, were compared after excluding patients older than 75 years, and patients with a history of prior lumbar surgery, or a predisposing medical condition, e.g. HIV disease, multiple myeloma, osteoporosis, metastatic disease, renal failure or severe degenerative disease. All studies were performed on a 1.5 T GE Signa/Excite. All case pairs were reviewed by three board certified radiologists, each with more than five years experience in MR imaging. Regardless of age, where a difference was perceived, the T1 FLAIR image was judged darker in 88% of patients. In order to avoid misdiagnoses and/or additional unnecessary exams, it is important to recognize that marrow signal intensity may appear artificially low in normal individuals.
Cauda Equina Cavernous Angioma Presenting as Acute Low Back Pain and Sciatica
Authors: Khalatbari M.R. , Hamidi M. , Moharamzad Y. , Taheri B.
Published: April 2015

Spinal cavernous angiomas are rare vascular lesions occurring mainly in the vertebral bodies extending secondary into the extradural space. Only 3% of these lesions are intradural, usually localized within the spinal cord. Rarely, cavernous angioma has been reported to occur in the cauda equina. We describe clinical, diagnostic imaging, and surgical procedures of two cases of cavernous angioma of the cauda equina who presented with acute back pain and sciatica. The relevant literature is also reviewed.
Advanced Ossification of the Posterior Longitudinal Ligament in a Mildly Symptomatic Patient
Authors: Conte G. , Viglianesi A. , D'Amore A. , Chiaramonte R. , Pecoraro C. , Nastasi L. , Giuffrida S. , Pero G. , Chiaramonte I.
Published: April 2015

We describe the imaging findings of a man who developed neurologic symptoms due to ossification of the posterior longitudinal ligament with narrowing of the spinal canal and compression of the spinal cord. CT study allowed a detailed evaluation of the stenosis and the extension of the ossification while MRI gave an excellent visualization of the spinal lesions caused by spinal cord compression by the mass. The neurological status of patients with ossification of the posterior longitudinal ligament depends on many factors such as the degree of spinal canal stenosis, life style, accidental mechanical stress and trauma.
Evaluation of Balloon Occlusion Test for Giant Brain Aneurysms under Local Anaesthesia
Authors: Hassan T. , Sultan A.E. , Elwany M.N.
Published: April 2015

We describe our experience in balloon test occlusion for giant carotid or basilar aneurysms under hypotension. Twenty-four patients underwent balloon test occlusion (BTO) during the year 2008. Only patients showed absence of any neurological deficits after 20 minutes under normal tension then another 20 minutes under hypotension were considered tolerable for occlusion of the parent artery. Of the 24 patients, four (16.67%) had deficits at normal tension and two (8.33%) had deficits at hypotensive phase. None of the 18 (75%) patients who clinically tolerated test occlusion and had parent artery sacrifice show any complication at follow-up period of two years. Two patients with clinical intolerability underwent carotid artery sacrifice after STA-MCA bypass without sequelae. Balloon test occlusion with hypotension is a useful, competent and simple technique in the evaluation of tolerance to parent artery occlusion in case of giant and complex intracranial aneurysms.
Intracranial Tumour Characterization: Whole Brain Evaluation with MR Perfusion Images and SPECT-CT
Authors: Aprile I. , Bencivenga S. , Loreti F. , Torni C.
Published: April 2015

A comparative study between perfusion magnetic resonance (MR) imaging and single photon emission tomography - computed tomography (SPECT-CT) was performed to disclose the indications and limits of the two techniques for brain tumour characterization. We compared these two techniques because they evaluate the entire brain and often a brain tumour can be too large to be studied entirely with MR spectroscopy. Forty-three patients with 56 lesions were studied with both techniques. The sensitivity in identifying neoplastic tissue was achieved. We did not evaluate the diagnostic sensitivity to differentiate high grade from low-grade tumours because the features of grade II astrocytomas with SPECT-methoxyisobutylisonitrile (SPECT-MIBI) are similar to those of normal brain tissue. Another question that advanced diagnostic techniques can solve is real glioma extension, but we did not consider also this aspect due to the low SPECT-MIBI spatial resolution. In 29 (29/56) cases both techniques accurately identified the presence of neoplastic tissue. Only SPECT-CT was positive in eight cases, whereas perfusion MR was falsely negative. Only perfusion MR identified tumoral tissue in four cases and SPECT-CT not. Finally both perfusion MR and SPECT-CT failed to identify neoplastic tissue in 15 cases out of 56. In most cases the diagnostic gain of both techniques was the same. One technique was superior to the other in only in a few cases. We conclude that, if available, both techniques can be used to study suspected brain tumours to better characterize the lesion.
Spontaneous Resolution in Dissecting Aneurysms of the Distal Middle Cerebral Artery
Authors: Yadav R.R. , Kumar A. , Somani R. , Phadke R.V.
Published: April 2015

Spontaneous resolution of intracranial aneurysms is a rare phenomenon. We describe two cases of ruptured distal middle cerebral artery branch aneurysms associated with initial neurological deficit. Follow-up angiography showed complete resolution of the aneurysms.
Treatment of a Symptomatic Epidural Gas Cyst Using an Angiographic 5F Catheter in the Epidural Space of the Spinal Cord through the Sacral Hiatus
Authors: Impiombato F. Ambesi , Lunghi V. , Gambacorta D. , Zocchi M.
Published: April 2015

An 85-year-old woman arrived at our institution because of left lumbar sciatica of about two years duration unrelieved by conventional oral pain therapy. A computed tomography scan obtained at the second visit showed an epidural gas cyst, with compression and dislocation of the left spinal nerve root L5. The common treatment of an epidural gas cyst is either a direct surgical approach or a CT-guided needle aspiration. We describe an alternative method to mechanical lysis of epidural gas cysts with the use of an 5F angiographic catheter inserted on a 0.035-inch guidewire. This procedure is less invasive than a surgical approach and safer than a CT-guided needle aspiration. Remission of symptoms was maintained at control visits at three and five months.
MRI Evaluation of the Temporomandibular Joints in Juvenile Rheumatoid Arthritis: A Retrospective Review
Authors: Davis M.A. , Castillo M.
Published: April 2015

The purpose of this study was to evaluate the MRI findings of children with rheumatoid arthritis (JRA) affecting the temporomandibular joints (TMJ) and correlate these findings with symptoms. MRI studies of the TMJ in 26 children with a clinical diagnosis of JRA were retrospectively reviewed. All studies included oblique and sagittal T1, T2*, proton density/T2, and coronal T1-weighted images. T1 and proton density/T2-images were repeated with the mouth open. Post contrast sagittal and coronal T1-images were obtained in 19 patients. All studies were done on either 1.5 Tesla or 3.0 Tesla units with dedicated surface coils. By consensus, two radiologists evaluated the studies for abnormal condyles, bone erosions, presence or absence of discs, effusions, contrast enhancement and pannus. Open mouth views were assessed for incomplete or abnormal translation. Clinical records were reviewed to correlate symptoms with MRI findings. Abnormal condyles were seen in 49%. Discs were identifiable in 71%. Abnormal translation was seen in 71% and pannus in 49%. Erosions were seen in 37%, effusions in 24% and contrast enhancement in 50%. Correlation with clinical examination showed that of five asymptomatic patients, three had abnormal translation. Fifteen patients presented joint asymmetry on clinical examination and all showed abnormal translation on MRI. Our findings suggest that abnormal translation and joint enhancement may be the most common MRI findings in JRA patients with TMJ arthritis. Abnormalities may occur even in the absence of symptoms and the most common finding in symptomatic patients is abnormal translation.
Spontaneous Regression of Dilated Virchow-Robin Spaces
Authors: Tortora F. , Cirillo M. , Belfiore M.P. , Pepe D. , Pezzullo F. , Barbarisi M. , Cirillo S.
Published: April 2015

We describe a 28-year-old woman with a dilated perivascular spaces in the right prerolandic district. The purpose of this article is to provide an in-depth overview of the MR imaging features of VR spaces and to describe magnetic resonance imaging evidence of complete regression of dilated perivascular spaces 2.
High-Grade Cerebral Glioma Characterization: Usefulness of MR Spectroscopy and Perfusion Imaging Associated Evaluation
Authors: Aprile I. , Torni C. , Fiaschini P. , Muti M.
Published: April 2015

The aim of our study was to evaluate if both spectroscopy and perfusion magnetic resonance (MR) imaging are necessary to differentiate high grade gliomas from low grade tumour, or if only one of these techniques is sufficient. Sixty-five patients with cerebral glioma were retrospectively evaluated. All patients were studied both with spectroscopy and perfusion imaging. In 43 cases histological examination showed a high grade glioma while a low grade glioma was found in 22 patients. For every patient spectroscopic maximum Cho/NAA ratio and lactate presence was established maximum relative CBV value was evaluated by perfusion MR. Both for Cho/NAA and rCBV threshold values were obtained by means of ROC curves. Then diagnostic sensitivity and specificity for high grade gliomas identification was evaluated for spectroscopic data only (Cho/NAA and lactate presence that was considered a high grade glioma marker), for perfusional data only (rCBV) and finally for both spectroscopic and perfusional data together. Sensitivity was significantly highest evaluating both spectroscopic and perfusional data together (89.7%) in comparison with spectroscopy (74.4%) or perfusion (79.4%) alone. Instead specificity was slightly lower with all data (91.7%) in comparison with spectroscopy (95.8%) and perfusion (95.8%) alone. In conclusion, to characterize high grade gliomas it is more useful to evaluate spectroscopic and perfusional data together with respect only one of these techniques alone.
Radiological Findings in Gliosarcoma
Authors: Swaidan M.Y. , Hussaini M. , Sultan I. , Mansour A.
Published: April 2015

Gliosarcomas are rare tumors with a poor prognosis composed of intermingled malignant glial and sarcoma elements with an estimated incidence of 1.8–8.0% of all malignant astrocytic neoplasms. We aimed to review the imaging findings in eight patients with gliosarcoma who were treated in our center between 2002 and 2010. The diagnosis was confirmed by morphological and immunohistochemical stains. This study, to the best of our knowledge, is the largest describing the imaging manifestations of this tumor. Although our study revealed no unique radiological features for gliosarcoma, it is important to note that they all demonstrated either dural or ependymal involvement or both. Calcification, hemorrhage or cystic components are described with a tendency for a ring enhancement pattern. Interestingly pre-existing benign looking lesions and associated remotely located small meningiomas are also described.
Selective Occipital Artery Sonography for Dural Arteriovenous Fistulas
Authors: Kono K. , Mori M. , Wakugawa Y. , Yasaka M. , Okada Y. , Nagata S.
Published: April 2015

Carotid duplex sonography is a useful method for evaluation of dural arteriovenous fistulas. The resistance index of the external carotid artery has been reported to correlate with the efficacy of treatment and recurrence or aggravation of dural arteriovenous fistulas. Herein, we describe a case of dural arteriovenous fistulas mainly supplied by the occipital artery and show that the resistance index of the occipital artery was more sensitive than that of the external carotid artery. To the best of our knowledge, this is the first report to describe the feasibility of occipital artery detection by carotid duplex sonography and clinical application of the resistance index of the occipital artery for dural arteriovenous fistulas.
Spontaneous Recanalization of the Occluded Internal Carotid Artery
Authors: Mohammadian R. , Arami M.A. , Mansourizadeh R. , Husainian M. , Abdkarimi M.H. , Mohammadian F.
Published: April 2015

Spontaneous recanalization of the occluded internal carotid artery (ICA) is more frequent than is generally believed. The timing of spontaneous recanalization remains unclear but it may occur as either an early or a late event. The aim of this case report is to emphasize the importance of spontaneous recanalization and its consequences. From September 2008 to November 2010 we prospectively followed patients with old ICA occlusion. The diagnoses of an occlusion were based on duplex scan findings and were confirmed by CT angiography and digital subtraction angiography (DSA). ICA occlusions secondary to dissection, inflammatory process, like fibromuscular dysplasia, previous stenting or endarterectomy and trauma, were excluded from the study. All patients had a scheduled carotid duplex scan every six months. Overall 65 patients were enrolled. Two patients showed evidence of spontaneous recanalization. A 55-year-old man with a known history of transient ischemic attack had occlusion in the left side ICA. He presented with another TIA eight months later. Investigations showed evidence of rcanalization of occluded ICA. This artery underwent uneventful stenting. In another patient recanalization was heralded by global aphasia and right side hemiplegia. He was a 70-year-old man with a history of recurrent TIA. Carotid duplex scan and DSA showed recanalization of the occluded left ICA accompanied by occlusion of the ipsilateral middle cerebral artery. He remained profoundly disabled with severe neurological deficits. In conclusion, spontaneous recanalization of the occluded internal carotid artery is a potentially complicated event that may lead to severe neurological disability.
Transient Brain Lesions in Neuro-Behçet's Disease without Systemic Involvement
Authors: Amato C. , Elia M.
Published: April 2015

In neuro-Behçet's disease nervous involvement may occasionally precede somatic manifestations, making the diagnosis challenging. The reported case showed only a neurologic onset with relapsing-remitting form, transient brain MRI abnormalities and late appearance of typical muco-cutaneous lesions, thereby delaying the correct diagnosis and appropriate treatment. MRI revealed cerebral alterations mimicking demyelinating disease, but lesions rapidly disappeared on close follow-up scans indicating vasogenic edema. Being aware of this atypical presentation and recognizing these transient abnormalities may be useful for a prompt diagnosis.
Magnetic Resonance Imaging of Cerebellar Liponeurocytoma
Authors: Guan J.T. , Geng Y.Q. , Cheng Y. , Guo Y.L. , Wu R.H.
Published: April 2015

Cerebellar liponeurocytoma is a rare benign neuroepithelial tumour. We describe the case of a 50-year-old man presenting with signs of increased intracranial pressure and cerebellar dysfunction. Magnetic resonance imaging showed a heterogeneous, well-circumscribed cerebellar mass with a predominant adipose content. Diffusion-weighted imaging showed an isointense mass with a hyperintense rim. Craniotomy demonstrated a soft grey mass with intratumoral bright patchy yellow areas. Histological and immunohistochemical findings indicated an advanced neuronal, glial and focal lipomatous differentiation with a low level of mitotic activity.
Influenza a H1N1 Related Acute Necrotizing Encephalopathy: Radiological Findings in Adulthood
Authors: Ventura E. , Summa A. , Ormitti F. , Picetti E. , Crisi G.
Published: April 2015

In 2009 a novel swine-origin Influenza A H1N1 virus was identified in Mexico and Southern California. Since it was first recognized, neurological complications including acute necrotizing encephalopathy (ANE) have been globally documented in association with this viral infection. ANE is mostly known to occur in the paediatric population. We describe a fatal case of ANE in a previously healthy 40-year-old man infected with influenza A H1N1 virus presenting with severe neurologic decline. Computed tomography (CT) scan and magnetic resonance imaging (MRI) findings were consistent with ANE. CT and MR findings typically documented in paediatric cases of ANE - including bilateral thalamic necrosis with petechial hemorrhage - have been seldom described in adulthood.
Calcifying Pseudoneoplasm of the Neuraxis
Authors: Muccio C.F. , Cerase A. , Leone A. , Dalena A.M. , Di Blasi A. , De Simone M. , Esposito G.
Published: April 2015

Calcifying pseudoneoplasm is rarely encountered along the neuraxis, and only few cases have been reported to involve the spine. Its exact pathogenesis is unknown, and has been regarded as an unusual reactive process which must be differentiated from infection or malignancy. This rare entity carries a good prognosis after surgical resection. We report on the computed tomography and magnetic resonance imaging and diffusion-weighted features of calcifying pseudoneoplasm of the spine by describing two patients with involvement of the craniocervical junction, and thoracic spine.
Cerebral Amyloid Angiopathy
Authors: Tzimou M. , Anastasiou A. , Katsarou Z. , Pyrpasopoulou A. , Douma S.
Published: April 2015

The aim of this report was to describe the case of an elderly patient with cerebral amyloid angiopathy and associated dementia who presented with new onset symptomatology compatible with an acute cerebrovascular event. Computed tomography scanning was suggestive of an incipient ischemic cerebrovascular event. Magnetic resonance imaging was requested due to the presence of small hyperdense lesions on CT, and revealed multiple diffuse hypodense parenchymal lesions with hemosiderin deposits, indicative of cerebral amyloid angiopathy. Diagnosis of the underlying pathology is of importance, as aspirin use, and antiplatelet use in general, may in these patients be associated with microbleed burden.
Complications Caused by Cerebral Arteriovenous Malformation Embolization
Authors: Sun Y. , Lv X. , Li Y. , Li A.
Published: April 2015

We describe the complications of endovascular embolization for cerebral arteriovenous malformations (AVMs). 164 consecutive patients with AVMs treated by endovascular embolization between 1998 and 2003 were retrospectively reviewed. Over a five-year period, 292 embolization procedures were performed in 164 patients with embolization as the primary treatment modality (n=126) or as an adjunct to surgery (n =14) or radiosurgery (n=24). There were a total of 15 (9.1% per patient, 5.1% per procedure) complications in this series, of which 14 were clinically significant (8.5% of patients, 4.8% per procedure), and one was a technical complication (0.6% of patients, 0.3% per procedure). Excellent or good outcomes (Glasgow Outcome Scale ≥4) were observed in 136 (82.9%) patients at discharge. Neurological deficits (Glasgow Outcome Scale 1–4) as a direct result of embolization were 7.3% at discharge. In a single-center, retrospective, nonrandomized study, 82.9% of patients had excellent or good outcomes at discharge after AVM embolization, with a complication rate of 5.1%.
Magnetic Resonance Spectroscopy for Differentiating Pseudo-Progression from True Progression in GBM on Concurrent Chemoradiotherapy
Authors: Sawlani V. , Taylor R. , Rowley K. , Redfern R. , Martin J. , Poptani H.
Published: April 2015

Neoadjuvant chemo-radiation therapy including temozolomide is commonly used for the treatment of gliomas. However, increased lesion size and contrast enhancement are frequently observed following this therapy and this appearance is termed as ‘pseudo-progression’. Since conventional imaging is unable to differentiate pseudo-progression from tumour recurrence, we evaluated the utility of MR spectroscopy (MRS) to differentiate these two pathological entities. Longitudinal MRI and MRS studies prior to and within four months post chemo-radiation therapy including diffusion-weighted imaging and single voxel spectroscopy (short and intermediate echo) were performed in 62 glioblastoma (GBM) patients undergoing chemo-radiation therapy. Clinical follow-up demonstrated four cases of pseudo-progression. In this study, results from these four cases and a known case of tumour recurrence are reported. Metabolite ratios and presence or absence of lipids at 1.3 ppm were used to differentiate between pseudo-progression and tumour recurrence. All four cases of pseudo-progression demonstrated elevated lipid signals on MRS. Additionally, an absence of choline or a low choline/NAA ratio was also observed. In comparison, the patient with tumour recurrence showed lower lipid signals and a high choline/NAA ratio. The presence of elevated lipid signals along with low choline/NAA ratios can aid in differentiation of pseudo-progression from tumour recurrence.
Leiomyosarcoma Leptomeningeal Brain Metastases
Authors: Kaduri S. , Tampieri D.
Published: April 2015

Brain metastases from soft tissue sarcomas (STS) occur late and relatively rarely, most commonly after lung metastases have developed. Furthermore, they are most commonly intraparenchymal in distribution. We describe two cases of histologically confirmed intracranial metastatic soft tissue leiomyosarcomas. In both cases all the nodular metastases measuring 10 mm in diameter or less could be easily detected in the leptomeningeal spaces by MRI. However, as the lesion enlarges it is difficult to recognize the site of origin, and the mass appears and behaves as intra-axial. Lesions located in the leptomeningeal spaces and in the perivascular space can be extremely small, which makes their detection problematic. For this reason we believe that in this context, MRI global gadolinium enhanced imaging using contiguous 1 mm slice thickness acquisition (TR 23 ms, TE 8 ms 512×512 matrix) is preferable, since the patient's management may vary depending on the multiplicity and location of the lesions.
Imaging of Cervical Extradural En-Plaque Meningioma
Authors: D'Amico A. , Napoli M. , Cirillo M. , D'Arco F. , D'Anna G. , Caranci F. , Mariniello G. , Brunetti A.
Published: April 2015

Meningioma is one of the most common spinal extramedullary tumors, largely intradural. An extradural localization is possible but less frequent. There are two morphologically different types of meningioma: one is round, and the other is the “en-plaque” form, that grows along the dura mater like a sheet. The “en-plaque” form, is unusual. We report on an unusual case of epidural and extraspinal “en-plaque” meningioma, describing the MRI and CT features and discussing the possible principal differential diagnosis (neurolymphomatosis, plexiform neurofibromas/schwannomas and metastasis).
Practical Aspects of Shortening Acquisition Time in Brain MR Susceptibility-Weighted Imaging
Authors: Tsai F.Y. , Shih Y.Y. , Chan W.P. , Tsai P.H. , Chung H.W.
Published: April 2015

Magnetic resonance susceptibility-weighted imaging (SWI), a novel 3D gradient echo MRI sequence exploiting phase and magnitude data for post-processing, is able to detect blood, iron, calcification and deoxygenated hemoglobin content for brain. SWI has been widely used to evaluate cerebral vascular disorders, trauma, multiple sclerosis, and tumors. We have also used SWI to evaluate acute stroke patients to identify thrombosis and possible penumbra. The acquisition was too long for examining acute stroke patients due to motion from agitation and mental changes. We have altered the parameters of phase resolution, voxel size, matrix size and partial Fourier to shorten the acquisition time to improve the diagnostic quality of SWI for acute stroke patients. The result was to reduce the acquisition time from 3:46 min to 2:14 min thereby providing a helpful tool in screening stroke patients.
Diffusion-Weighted Imaging of the Early Phase of Wallerian Degeneration
Authors: Bekiesinska-Figatowska M. , Duczkowski M. , Madzik J. , Uliasz M. , Zawadka A. , Baszczeska J.
Published: April 2015

Wallerian degeneration (WD) affects axons and their myelin sheaths distally from the site of injury of the axon and/or body of the neuron. There is limited knowledge about brain injuries in newborns, mostly because non-invasive imaging sensitive enough to detect subtle changes was not available. Diffusion-weighted magnetic resonance (MR) imaging (DWI) is sensitive in the detection of early injury to the corticospinal tracts (CST) before the occurrence of WD in distal segments. We describe the cases of 14- and seven-day-old newborns in whom MR imaging revealed vascular injury in the territory supplied by the middle cerebral artery, and early development of WD. We performed DWI and faced an unexpected finding because DWI hyperintensities were at the same time hyperintense on T2-weighted images. Hyperintense structures on DWI are supposed to reflect pre-Wallerian injured tissue, which should not be visible on standard MR sequences, while their T2- signal indicated the third, late subacute phase of WD. It seems that time-related stages of WD observed in adults do not necessarily apply to the immature brain of newborns/infants as reflected by differences in signal intensity in various MR sequences. DWI hyperintensity in CST below infarct should not be mistaken for new ischemic foci.
Challenging Pyogenic Cerebral Abscess Complicated by Subdural Empyema
Authors: Valencia M.P. , Moon A.
Published: April 2015

Brain abscesses develop in response to a parenchymal infection with pyogenic bacteria, beginning as a localized area of cerebritis and evolving into a suppurative lesion surrounded by a well-vascularized fibrotic capsule. The leading etiologic agents of brain abscess are the streptococcal strains and S. aureus. Abscesses may also be secondary to fungal or parasitic organisms. Brain abscess represents a significant medical problem, accounting for one in every 10,000 hospital admissions in the United States, and remains a serious situation despite recent advances made in detection and therapy. These lesions often produce complex clinical and radiologic findings and require prompt recognition and treatment to avoid a fatal neurologic outcome. Subdural empyema represents an important type of intracranial suppurative infectious-inflammatory disorder. Clinically, these patients initially have signs and symptoms of meningitis, but this course might be complicated later by the development of seizures and focal neurologic signs.
Pediatric Inflammatory Diseases
Authors: Gallucci M. , Smith J.D. , Limbucci N. , Giangaspero F. , Rossi A.
Published: April 2015

Acute post-infectious immune disorders include Acute Disseminated Encephalomyelitis (ADEM) and its variants such as Acute Hemorrhagic Encephalomyelitis (AHEM), acute necrotizing hemorrhagic leukoencephalitis (ANHLE) of Weston Hurst, multiphasic and recurrent ADEM. Acute Necrotizing Encephalopathy of Childhood (ANE or ANEC) represents a dramatic event, consequent to viral infections, especially Influenza-A, and is now considered different from ADEM. ADEM and variants are classically described as uniphasic syndrome occurring in association with an immunization or vaccination (postvaccine encephalomyelitis) or systemic viral infection (parainfectious encephalomyelitis). However, multiphasic forms are not rare. Pathologically, there is perivascular inflammation, edema, and demyelination within the CNS. Clinical features are focal or multifocal neurologic disorder following exposure to virus or receipt of vaccine. The onset of the CNS disorder is usually rapid and include encephalopathy ranging from lethargy to coma, seizures, and focal and multifocal signs reflecting cerebral and spinal cord involvement. The mortality rate is estimated at 10 to 30 percent, with complete recovery rates of 50 percent cited. Poor prognosis is correlated with severity and abruptness of onset of the clinical syndrome. Multifocal CNS lesions are generally evident on MRI that can be similar from those observed in MS.
Pediatric Inflammatory Diseases
Authors: Splendiani A. , Catalucci A. , Limbucci N. , Turner M. , Krings T. , Gallucci M.
Published: April 2015

Central nervous system (CNS) vasculitis can affect both adults and children, but some of these occur almost exclusively in childhood. In children may develop as a primary condition or secondary to an underlying systemic disease. Cerebral vasculitis can be classified on the basis of the diameter of the involved vessels, although there is no univocal consensus. The diagnosis of CNS vasculitis is particularly difficult because the available investigative modalities have limited sensitivities and specificities. The most helpful diagnostic tests include cerebrospinal fluid analysis, MRI (MR angiography/venography (MRA/MRV) of the brain, and angiography. However, brain biopsy may be required to diagnose small vessel vasculitis in order to make differential diagnosis with a wide range of conditions, such as degenerative vasculopathies, embolic diseases, or coagulation disorders. This paper discusses on current understanding of most frequent primary and secondary central nervous system vasculitis in children in which are involved small vessel.
Basilar Artery Hypoplasia
Authors: Caranci F. , Napoli M. , Cirillo M. , Briganti G. , Brunese L. , Briganti F.
Published: April 2015

A rare case of segmental hypoplasia of the basilar artery is described in a 49-year-old man with transient vertebrobasilar ischemia, explored by magnetic resonance imaging (MRI) and digital angiography (DA). The embryology, clinical relevance and magnetic resonance findings of this arterial anomaly are discussed, with a review of six previously reported cases. Segmental aplasia was suggested in our case by magnetic resonance, and subsequently confirmed not only by time-of-flight magnetic resonance, but also by DA. Only ultrathin-slice T2-weighted images revealed the real finding of basilar artery hypoplasia. This sequence, not employed in previously reported cases, is mandatory to allow a clear differential diagnosis between basilar artery aplasia and hypoplasia.
Small Intracranial Lipomas may be a Frequent Finding on Computed Tomography of the Brain
Authors: Gossner J.
Published: April 2015

Intracranial lipomas are described as a rare finding. In this small retrospective analysis of 50 cases undergoing brain CT for various reasons small intracranial lipomas where found in nine patients. In contrast to previous reports lipomas may be a frequent finding on CT imaging of the brain. In particular, these small lipomas seem to be incidental findings lacking clinical relevance. Radiologists should be aware of intracranial lipomas to establish proper differential diagnosis.
Intratumoral Haemorrhage Causing an Unusual Clinical Presentation of a Vestibular Schwannoma
Authors: Gagliardo C. , Martines F. , Bencivinni F. , La Tona G. , Lo Casto A. , Midiri M.
Published: April 2015

We present a case of an elderly woman with no history of audiological disease with sudden onset of visual and hearing deficits associated with systemic clinical signs. On examination she had impairment of right CNs from V to X. CT and MR imaging demonstrated a cystic vestibular schwannoma with a rare intralesional fluid-fluid level correlated to a recent bleed. We include high quality MR images to show the acute impairment of the cranial nerves next to the tumour after acute bleeding. Our case report includes a voxel-based morphometry (VMB) analysis of the tumour that, as far as we know, has never been done before for such a tumour. VBM analysis was performed to calculate the hypothesized volume changes after the acute bleed which likely resulted in a sudden increase in the overall size of the tumour resulting in atypical clinical signs and symptoms due to the establishment of a mechanical conflict with the adjacent cranial nerves.
Stroke Atlas: A 3D Interactive Tool Correlating Cerebrovascular Pathology with Underlying Neuroanatomy and Resulting Neurological Deficits
Authors: Nowinski W.L. , Chua B.C.
Published: April 2015

Understanding stroke-related pathology with underlying neuroanatomy and resulting neurological deficits is critical in education and clinical practice. Moreover, communicating a stroke situation to a patient/family is difficult because of complicated neuroanatomy and pathology. For this purpose, we created a stroke atlas. The atlas correlates localized cerebrovascular pathology with both the resulting disorder and surrounding neuroanatomy. It also provides 3D display both of labeled pathology and freely composed neuroanatomy. Disorders are described in terms of resulting signs, symptoms and syndromes, and they have been compiled for ischemic stroke, hemorrhagic stroke, and cerebral aneurysms. Neuroanatomy, subdivided into 2,000 components including 1,300 vessels, contains cerebrum, cerebellum, brainstem, spinal cord, white matter, deep grey nuclei, arteries, veins, dural sinuses, cranial nerves and tracts. A computer application was developed comprising: 1) anatomy browser with the normal brain atlas (created earlier); 2) simulator of infarcts/hematomas/aneurysms/stenoses; 3) tools to label pathology; 4) cerebrovascular pathology database with lesions and disorders, and resulting signs, symptoms and/or syndromes. The pathology database is populated with 70 lesions compiled from textbooks. The initial view of each pathological site is preset in terms of lesion location, size, surrounding surface and sectional neuroanatomy, and lesion and neuroanatomy labeling. The atlas is useful for medical students, residents, nurses, general practitioners, and stroke clinicians, neuroradiologists and neurologists. It may serve as an aid in patient-doctor communication helping a stroke clinician explain the situation to a patient/family. It also enables a layman to become familiarized with normal brain anatomy and understand what happens in stroke.
Vascular Cerebral Anomalies Associated with Septo-Optic Dysplasia
Authors: Chiaramonte I. , Cappello G. , Uccello A. , Guarrera V. , Damore A. , Cavallaro T. , Chiaramonte R. , Ettorre G.C.
Published: April 2015

We describe a case of Septo-Optic Dysplasia (SOD) characterized by the presence of anomalous cerebral vessels. In our young patient the classical features of SOD were associated with vascular anomalies including absence of the vein of Galen, right Rosenthal vein leading to the superior petrosal sinus, and anomalous origin of the anterior choroidal arteries. These findings have never been associated with SOD in the literature but their revelation supports the hypothesis of a vascular disruption as a possible cause of the SOD.
Spontaneous Resolution of Chiari Type 1 Malformation
Authors: Briganti F. , Leone G. , Briganti G. , Orefice G. , Caranci F. , Maiuri F.
Published: April 2015

We describe a 62-year-old woman who presented with a history of ataxia, dizziness and urinary urgency. Neurological examination disclosed a positive Romberg sign, ataxia and postural instability. A magnetic resonance imaging (MRI) scan showed Chiari type 1 malformation (CM1). Forty-eight months later, the patient was clinically improved and underwent a second MRI examination, which showed complete resolution of the Chiari 1 malformation. Spontaneous resolution of CM1 is exceptionally rare and has to be considered in the radiological and clinical management.
Endovascular Treatment of Vertebro-Vertebral Arteriovenous Fistula
Authors: Briganti F. , Tedeschi E. , Leone G. , Marseglia M. , Cicala D. , Giamundo M. , Napoli M. , Caranci F.
Published: April 2015

This report describes endovascular approaches for occlusion of vertebro-vertebral arteriovenous fistula (W-AVF) in a series of three cases and a review of the literature. Complete neuroimaging assessment, including CT, MR and DSA was performed in three patients (two female, one male) with W-AVF. Based on DSA findings, the W-AVF were occluded by endovascular positioning of detachable balloons (case 1), coils (case 2), or a combination of both (case 3) with parent artery patency in two out of three cases. In this small series, endovascular techniques for occlusion of W-AVF were safe and effective methods of treatment. To date, there are no guidelines on the best treatment for W-AVF. Detachable balloons, endovascular coiling, combined embolization procedures could all be considered well-tolerated treatments.
Double Ophthalmic Artery Visualized with New Technology
Authors: Namba K. , Nemoto S.
Published: April 2015

The anatomy of the double ophthalmic artery was visualized using fused imaging. The images demonstrate the first angiographic visualization of the course of the vessel.