bluuebunny/crossref_metadata_2025 huggingface dataset:
Management of Painful Neoplastic Spinal Lesions Using Percutaneous Acrylic Cement Injection
Authors: Gupta A.K. , Purkayastha S. , Kapilamoorthy T.R. , Bodhey N.K. , Sarma S.R.
Published: April 2015

Debilitating backache due to different types of neoplastic spinal lesions is a common cause of morbidity in different age groups. Percutaneous vertebroplasty (PV) gives substantial pain relief and stabilizes the weak vertebrae. The objective of our study was to assess the therapeutic benefit of PV in alleviating backache and improving functional status in patients with painful neoplastic conditions of vertebrae. A retrospective hospital-based (tertiary teaching hospital) study of 13 patients was undertaken from January 2001 to January 2005. Nineteen vertebroplasties were done in seven male and six female patients. The Wilcoxon Signed Rank test was used to evaluate the statistical significance of differences between the preoperative and postoperative levels of pain, mobility and analgesic usage. Most patients had pain relief within 48–72 hours. No patient had any added deficit related to the procedure. At one to 48 months follow-up the patients had a statistically significant improvement in their clinical condition (p<0.001). PV is effective in relieving debilitating backache and can improve the functional status of patients with painful vertebrae harboring various neoplastic lesions.
The Role of Dynamic Contrast-Enhanced Magnetic Resonance Imaging Parameters in Head-Neck Tumors
Authors: Unlu E. , Albayram S. , Temizoz O. , Caloglu M. , Tamer Y.
Published: April 2015

We evaluated dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) in various head-neck masses, some of which are very rare tumors whose DCE-MRI have not been published to date. The purpose of this study was to investigate DCE-MRI in the differentiation of benign versus malignant lesions and to evaluate the DCE-MRI parameters most predictive for malignancy. Forty-one head-neck tumors including parotid gland tumors in 41 patients were examined at gadolinium-enhanced dynamic MR imaging. There were 26 malignant and 15 benign tumors. DCE-MR images were obtained between four and six minutes. Time-signal intensity curves (TICs) of the tumors on dynamic MR images were plotted, and then time of peak enhancement ( Tpeak), and enhancement ratios (ER) with different times (such as ER30, ER60, ER90, ER120, ERmax) were also calculated. Data of the benign and malignant group with head-neck masses were compared by Mann-Whitney U-test. The mean values of time to peak ( Tpeak) were found to be significantly shorter for the malignant group than the benign tumors ( P<0.05). The mean enhancement rates of malignant lesions were ER30: 60.62±52.62, ER60: 105.65±56.26, ER90: 113.17±45.83, ER120: 116.59±46.75 and ERmax: 128.56±56.51 whereas the mean enhancement rate of benign lesions were ER30: 67.35±60.78, ER60: 79.79±63.33, ER90: 84.53±64.92, ER120: 88.41±67.07 and ERmax: 112.06±66.48. The mean signal intensity values of the 60th second (ER60) and 90th second (ER90) were significantly different from other values for predicting malignancy ( P<.05). The parameters obtained from the time-signal intensity curve are important in differentiating benign and malignant enhancing lesions in dynamic head-neck MR imaging. DCE-MRI cannot replace standard MR imaging sequences for evaluating head-neck masses, but in addition to routine MR imaging it will improve differentiation between benign and malignant lesions.
Fusiform Basilar Artery Aneurysm Rapid Death with Occlusion and Subdural-Subarachnoid Hemorrhage
Authors: Senocak E. , Oguz B. , Cila A.
Published: April 2015

Fusiform aneurysms of the posterior circulation constitute a relatively uncommon subgroup of aneurysms. We present a patient with fusiform basilar artery aneurysm accompanied by ectasia and elongation of both supraclinoid parts of the internal carotid arteries, middle cerebral arteries and vertebral arteries. The aneurysm had thrombus formation along its length which progressed to occlude the lumen the day after the patient's admission. Mass effect, progressive infarcts at the territories of posterior inferior cerebellar (PICA) and superior cerebellar (SCA) arteries and brainstem perforators along with subarachnoid and subdural hemorrhage were present.
Transoesophageal Echocardiography in Patients with Stroke and Low Risk of Embolic Etiology
Authors: Chlumský J. , Bojar M. , Šváb P. , Bruthans J.
Published: April 2015

Transoesophageal echocardiography (TEE) is currently the gold standard in the diagnosis of cardiac sources of embolization and the frequently discussed question is whether all patients with suspected embolic stroke should be screened by TEE. Based on the results of transthoracic echocardiography (TTE), we determined the significance of TEE in patients with ischemic stroke with low risk of embolic etiology. We made a retrospective evaluation of TEE examination in the period from 1st January 2000 to 31st December 2003 in patients with ischemic stroke and sinus rhythm and normal left ventricular function. TEE examination was done in 159 patients. A quarter of the patients had pathological findings in the heart: left atrial thrombus in nine (5.7%), spontaneous echocontrast in left atrium in 14 (8.8%), patent foramen ovale in 16 (10%) and other findings in seven (4.4%) patients. The finding of the thrombus or echocontrast in the left atrium correlated with the size of the left atrium and it was proved in the patients with left atrium of size above 39 mm. On the contrary, patent foramen ovale was found in younger patients (70 vs. 59 years). Our results have shown that TEE is of low relevance to patients with a normal transthoracic echocardiogram.
Imaging of Craniofacial and Sinonasal Anomalies
Authors: Hasso A.N. , Kim-Miller M.J.
Published: April 2015

Whereas CT imaging techniques such as multiple detector spiral imaging with multi-planar reconstructions are desirable in the evaluation of congenital and developmental anomalies of the midface and skull base, there is an essential role for MRI whenever there are related intracranial anomalies. This presentation will focus on describing and classifying the known craniofacial anomalies that have common manifestations in the sinonasal regions, the orbits, and the skull base. Diagrams and clinical cases are utilized to demonstrate the key embryological events leading to the common dysplasias of the craniofacial and sinonasal regions.
Measuring CSF Flow in Chiari I Malformations
Authors: Haughton V.M. , Iskandar B.J.
Published: April 2015

Cardiac-gated Phase Contrast MR (PC MR) is used in the evaluation of the Chiari I malformation to assess the CSF flow though the foramen magnum. Images may show reduced CSF flow posterior to the spinal cord in patients with a Chiari I malformation. MR images however do not differentiate with sufficient accuracy between symptomatic and asymptomatic Chiari I malformations. In the presence of the Chiari I malformation, CSF velocities are elevated. Measuring the velocity of flow and determining the degree of inhomogeneity in CSF flow aid in the detection of clinically significant flow abnormalities.
Imaging Dementing Illnesses
Authors: Huckman M.S.
Published: April 2015

Dementia is an impairment of mental ability representing a decline from that level previously reached by the individual. It is usually of insidious onset, associated with neurologic changes, and results in the inability to appropriately interact with one's environment. Dementias may be static, progressive, or reversible, and have many etiologies. One percent of the population above age 40 suffers from dementia and this figure rises to 7% above age 80 and 50% above age 90. Forty-five percent of dementias are due to Alzheimer disease (AD) followed closely by vascular dementia. A stage along the way to dementia is mild cognitive impairment (MCI). There are various definitions but the simplest ones refer to a person who has some memory problems but can continue to live independently. A more specific description refers to deficits in two or more areas of cognition >1.5 SD below mean for the individuals age and education. Although previously considered a part of normal aging, a recent study has shown MCI to be a precursor of Alzheimer disease1. In a cohort of nuns and priests studied annually until they developed MCI or dementia and died. 180 brains in this study have already been autopsied (37 MCI, 60 with no impairment, 53 with dementia). Pathologists measured theamount of AD pathology and cerebral infarcts. Of 37 with MCI, more than half had AD by pathology, 1/3 had infarcts (5 with both) and 14 did not have either pathology. One third of the 180 with average age of 85 had no cognitive decline! Since this study showed MCI patients to have Alzheimer disease pathology in their brains, recognition of MCI clinically is important for institution of therapy, although there has not yet been an effective therapy developed.
Late Relapse of Pediatric Medulloblastoma
Authors: Stosic-Opincal T. , Golubicic I. , Cvetkovic D. , Popovic V. , Antunovic V.
Published: April 2015

Medulloblastoma ( MB), the most common malignant brain tumor of childhood, is classified according to pathomorphologic characteristics in the group of central nervous system embryonal tumors, but both its pathogenesis and biologic behavior remain unknown. In addition, the relationship of MB to other embryonal brain tumors is debated and response to therapy is difficult to predict. The authors report an uncommon case of unfavorable late relapse, local as well as distant, in a 26-year old male patient, who was free of disease and without treatment-related morbidity for fifteen years after combined therapy for pediatric MB.
Agenesis of the Internal Carotid Artery and Hypogenesis of the Pituitary Gland: Cause, Consequence or Coincidence?
Authors: Seixas D. , Ayres-Basto M. , Fontoura M. , Silva M.L. , Fonseca J.
Published: April 2015

The CT and MR imaging findings in a case of unilateral agenesis of the internal carotid artery and hypogenesis of the pituitary gland are described in a child with congenital hypopituitarism. The embryological pathogenesis is discussed.
Fat Saturation Technique and Gadolinium in MRI of Lumbar Spinal Degenerative Disease
Authors: D'Aprile P. , Tarantino A. , Lorusso V. , Brindicci D.
Published: April 2015

We evaluated the potential of MR sequences with Fat Saturation and gadolinium in patients with degenerative disease of the lumbar spine and low back pain, by studying both anterior and posterior elements of the lumbar spine. We examined 3323 patients (age range 15–78 years) presenting low back pain. We used T2-weighted sequences with Fat Saturation and in some selected cases (1063 patients, 32%) administered gadolinium using T1-weighted sequences with Fat Saturation. In particular we used gadolinium in the following cases: 1) presence of hyperintense areas on T2 weighted images with Fat Saturation in the osteo-articular and muscular-ligamentous structures of the lumbar spine; 2) Clinical-radiological discrepancy in patients without disc-root conflict and clinical suspicion of posterior vertebral compartment syndrome. We found degenerative-inflammatory changes in osteo-articular, ligamentous and muscular structures in 1063 patients: osteochondrosis, “aseptic discitis”, facet joint effusion and synovitis, osteoarthritis, synovial cysts, spondylolysis, degenerative-inflammatory changes of the posterior ligaments (flava, interspinous and supraspinous ligaments) and posterior perispinal muscles. To improve diagnostic accuracy and allow correct therapeutic guidance, MR examination in patients with low back pain must evaluate both anterior and posterior elements of the lumbar spine. Our study indicates that T2 sequences with Fat Saturation and, in selected cases, gadolinium administration, better visualize or disclose degenerative-inflammatory changes in the lumbar spine, showing the active-inflammatory phase and extension of these processes which may not be depicted during a standard MR examination.
Non-Inferential Multi-Subject Study of Functional Connectivity during Visual Stimulation
Authors: Esposito F. , Cirillo M. , Aragri A. , Caranci F. , Cirillo L. , Di Salle F. , Cirillo S.
Published: April 2015

Independent component analysis (ICA) is a powerful technique for the multivariate, non-inferential, data-driven analysis of functional magnetic resonance imaging (fMRI) data-sets. The non-inferential nature of ICA makes this a suitable technique for the study of complex mental states whose temporal evolution would be difficult to describe analytically in terms of classical statistical regressors. Taking advantage of this feature, ICA can extract a number of functional connectivity patterns regardless of the task executed by the subject. The technique is so powerful that functional connectivity patterns can be derived even when the subject is just resting in the scanner, opening the opportunity for functional investigation of the human mind at its basal “default” state, which has been proposed to be altered in several brain disorders. However, one major drawback of ICA consists in the difficulty of managing its results, which are not represented by a single functional image as in inferential studies. This produces the need for a classification of ICA results and exacerbates the difficulty of obtaining group “averaged” functional connectivity patterns, while preserving the interpretation of individual differences. Addressing the subject-level variability in the very same framework of “grouping” appears to be a favourable approach towards the clinical evaluation and application of ICA-based methodologies. Here we present a novel strategy for group-level ICA analyses, namely the self-organizing group-level ICA (sog-ICA), which is used on visual activation fMRI data from a block-design experiment repeated on six subjects. We propose the sog-ICA as a multi-subject analysis tool for grouping ICA data while assessing the similarity and variability of the fMRI results of individual subject decompositions.
3 Tesla MR Study of Cerebellar Medulloblastoma
Authors: Battaglia S. , Riccioli L. Albini , Zucchelli M. , Leonardi M.
Published: April 2015

Medulloblastoma belongs to the group of highly malignant neuroepithelial tumours and is the commonest tumour in childhood (average age nine years) followed by astrocytoma1. Medulloblastoma usually arises in the posterior fossa, namely the cerebellar vermis, and more seldom in the fourth ventricle, supratentorium and spinal cord. We describe the 3 Tesla magnetic resonance (MR) features of a medulloblastoma located in the right cerebellar hemisphere adhering to the tentorium in a 16-year-old male.
Ectopic Suprasellar Pituitary Adenoma
Authors: Caranci F. , Cirillo L. , Bartiromo F. , Ferraioli M. , Del Basso De Caro M.L. , Esposito F. , Cappabianca P. , Brunetti A. , Elefante R.
Published: April 2015

The occurrence of a pituitary adenoma located entirely outside the sella turcica, so-called ectopic adenoma, is extremely rare. We report a case of a non secreting-pituitary adenoma located above the diaphragma sellae, with no invasion into the sella turcica, confirmed at surgery. The tumor was initially treated unsuccessfully by operations via the transphenoidal route. After initial negative exploration by the transphenoidal route, the patient was successfully treated by an endoscopic endonasal transphenoidal approach extended to the tuberculum sellae and the posterior planum sphenoidale to access the suprasellar supraglandular region. A brief review of ectopic adenomas and a discussion of the preoperative diagnosis are presented.
Geniculo-Temporo-Parotideal Neurofibroma of the Facial Nerve
Authors: Yilmaz F. , Gurel K. , Gurel S. , Sessiz N. , Boran C.
Published: April 2015

Preoperative diagnosis of facial nerve neurofibroma is difficult when it presents as an asymptomatic parotideal mass. Facial nerve tumor suspicion arises during parotid surgery, histopathologic evaluation confirms diagnosis and postoperative imaging demonstrates a nerve tumor and its extension. We present the multimodality imaging findings of a 43-year-old man with a solitary neurofibroma involving the whole facial nerve continuously from geniculate ganglion to parotideal segment as the first case in the literature.
Bilateral Internal Carotid Artery Segmental Agenesis Associated with Persistent Trigeminal Artery, Vascular Ectasia, Abnormal Configuration of Brain Stem and Cerebellum
Authors: Garg A. , Mishra N.K. , Gaikwad S.B. , Gupta V
Published: April 2015

Bilateral segmental agenesis of the internal carotid artery is a rare developmental anomaly. We report a case of congenital bilateral internal carotid arteries segmental agenesis associated with persistent trigeminal artery, vascular ectasia and abnormal configuration brain stem and cerebellum. We postulate that these findings could result from interference in development during the early stages.
CT Perfusion in Spinal Disease: An Adjunct Tool to Vertebral Body Biopsy
Authors: Shankar J.J.S. , Jayakumar P. N. , Vasudev M.K. , Ravishankar S.
Published: April 2015

Routine diagnostic techniques are inadequate for diagnosis of spinal diseases. The purpose of this study was to determine whether CT perfusion can differentiate inflammatory diseases like tuberculosis from neoplastic diseases of spine. Thirty-two patients with vertebral body lesions associated with paraspinal mass underwent CT guided bone biopsy and histopathological evaluation. CT perfusion was done in all patients before doing biopsy. Perfusion parameters like blood volume (BV), blood flow (BF) and time to peak (TTP) were calculated and correlated with histopathology. Statistical analysis was done using Mann-Whitney test. p value <0.05 was considered significant. Of 32 cases, 20 had tuberculous osteomyelitis and 12 neoplastic disease (seven metastasis, three plasmacytoma, one each lymphoma and chordoma). Mean rBF was [inflammatory lesions, 1.459 and neoplastic lesions, 18.080 (p<0.000). Mean rBV was (inflammatory disease, 2.8589 and neoplastic lesions, 12.2133 (p<0 .000)). Mean rTTP was [inflammatory pathology, 1.041 and neoplastic pathology, 0.703(p<0.079)]. This shows the deconvolution-based CTP technique's potential for noninvasive diagnosis of at least all inflammatory lesions affecting the spine that are associated with paraspinal mass. Validation of the use of deconvolution CTP parameters for differentiation of inflammatory from neoplastic pathology may permit this technique to be used as an adjunct tool when biopsy when routine imaging findings are inconclusive.
Facial Steal Syndrome: Identification and Endovascular Management
Authors: Kostanian V.J. , Mathews M.S. , Westhout F.D. , Yu Wengui
Published: April 2015

We describe a case of intraprandial vertebro-basilar insufficiency secondary to posterior cerebral circulation ischemia. Secondary collateralization was seen from facial and external carotid artery branches to the posterior circulation causing facial arterial steal during mastication. This condition was treated endovascularly. Occluded common and external carotid arteries were revascularized via angioplasty and stenting. The patient was able to undergo coronary artery bypass and right hip replacement in the following two months without cerebrovascular complications.
Angiographic and Clinical Results after Endovascular Treatment for Middle Cerebral Artery Berry Aneurysms
Authors: Hirota N. , Musacchio M. , Cardoso M. , Villarejo F. , Requelme C. , Tournade A.
Published: April 2015

Sixty-five middle cerebral artery (MCA) aneurysms in 59 patients treated by endovascular treatment (EVT) without the remodelling technique were analyzed. For ruptured aneurysms, the patients in bad condition are predominant and those with Fisher group four is 47.8% and with Hunt and Hess grade (HHG) IV or V are 43.5%. The clinical result is that 58.7% is in mRS 0–3, 21.7% in 4–5 and 19.6% in death. Contrary, 92.3% of the patients in HHG I-III resulted in mRS 0–3. Re-rupture was observed in two cases (4.4%). For all the aneurysms, thromboembolic complications were observed in 12.3% and those were predominant in the aneurysms greater than 10mm in diameter (p<0.05). Hemorrhagic ones occurred in 6.2% which were predominant in the aneurysms less than 10mm in diameter. No mortality was observed by the accidents. In follow-up angiography, Raymond classification was employed and Complete Obliteration or Dog Ear was observed in 24 of 43 cases (55.8%). Recanalization occurred in 10.5% of the cases with complete or almost complete obliterated aneurysms. These results suggested that EVT for the ruptured MCA aneurysms with good grade or the unruptured ones is feasible. Strict follow-up is important like the other aneurysms.
The Relationship between Carotid Artery Diameter and Percentage of Stenosis
Authors: Chao A-Ching , Chu Wei-Fa , Teng Michael Mu Huo , Sun Ying-Chou , Chang Feng-Chi , Luo Chao-Bao
Published: April 2015

In order to understand percentage of stenosis from the residual lumen of the carotid artery, we explored the relationship between the residual diameter at the carotid stenosis, its stenosis percentage and the size of the internal carotid artery. Diameters of 103 carotid arteries of Taiwan residents were retrospectively measured from digital subtraction angiograms. Severe cases of near occlusion with the angiographic string sign, and cases with tandem lesions or intracranial occlusion were excluded. Of the total 103 carotid arteries, 22 (21%) had one or both of the following signs of reduced distal arterial caliber: (1) obvious narrowing of the distal carotid artery; (2) the caliber of the cervical internal carotid artery was smaller than the caliber of the corresponding external carotid artery. That the diameter of the distal carotid artery was smaller when the stenosis was greater at the site of minimal lumen was true in the group of patients with signs of reduced distal caliber and in the group of patients without such signs. Therefore, reduced distal caliber may be present in patients without such signs. After excluding cases with at least one of the above signs of reduced distal arterial caliber, the relation between percentage of stenosis (y) and the absolute value of the diameter at the stenosis (x) can be represented by the formula: y = 96.83–18.27 x. From our data, a diameter of 2 mm is about 60% stenosis and 1.5 mm is 70% stenosis. According to this formula, we can estimate percentage of carotid stenosis using residual diameter at the site of minimal lumen obtained from other imaging modalities, such as carotid Doppler, CT angiogram or MR angiogram.
Preoperative Integrated Imaging in Paediatric Cochlear Implantation
Authors: Lupo F.A. , Sticchi G. , Paladini A. , Perfetto S.C. , Perrone A. , De Benedetto M. , Vitale S.
Published: April 2015

Sensorineural hearing loss affects one to two children out of 1000 born apparently healthy and 9% approximately of those born with the risk of different pathologies. The origin of premature deafness is unknown in 25% of children whereas it is genetic in some cases. Prevention and early diagnosis, possibly within six to eight months, aim to avoid deafness becoming a cause of disability. The aim of the present study was to establish the optimal preoperative assessment with a diagnostic imaging protocol involving the integrated use of CT and MRI in the selection of the candidates for cochlear implantation. Twenty children were assessed, divided into three different groups: A) those who had CT only; B) those who had only MR; C) those who had both CT and MRI. The purpose was to estimate diagnostic accuracy in preoperative planning and the role of imaging in the diagnostic protocol for children's deafness. The petrous pyramid was studied with a CT Picker PQ 6000 system to high resolution in the axial and coronal planes, and with an MR Intera Philips 0.5 T device by means of acquisition of sequences B-TFE T2 3D and MIP reconstructions on radial coronal plans. This study was completed successfully for morphological brain MRI examination to complete the diagnosis. The following abnormalities were found in six patients (30%): one case of incomplete partition (Mondini malformation); two cases of vestibular aqueduct enlargement; two cases with anomalous jugular bulb positioning; one case with cochlear ossification. In the remaining 70%: eight patients had no anatomical anomalies; CT and MRI imaging were normal in six patients with minor abnormalities disclosed at surgery (one case of the stapedial artery emerging from the promontory); three anatomical variants of the round window, and two abnormal course of the facial nerve). We emphasize the importance of integrated CT and MRI imaging in the study of children with sensorineural hearing loss. The combination of CT and MRI has been shown to be superior to either modality used alone in view of “risk-free” cochear implantation. High resolution computed tomography and magnetic resonance images obtained by B-TFE T2-weighted 3D sequences help the surgeon in planning the operation and predict operative difficulty and potential complications in paediatric cochlear implant candidates.
Ossified Posterior Longitudinal Ligament with an Atypical Clinical Presentation in an Indian Male
Authors: Purkayastha S. , Choudhury H.R.
Published: April 2015

Ossification of the posterior longitudinal ligament is an uncommon disorder mostly seen in the Japanese population and hence termed by some the “Japanese disease”. Ossification of the posterior longitudinal ligament is more common in the cervical spine2. Clinically it is usually asymptomatic, but serious neurological deficits have been seen in some patients2. The ossified mass composed of lamellar bone and focal calcified cartilage expands in volume causing spinal canal stenosis and cord compression. Morphologically, four forms of ossification of the posterior longitudinal ligament have been described: continuous, segmental, mixed and rarely a focal retrodiscal form4. CT scan is the method of choice for detecting the presence and extent of the ossified mass. MR imaging is helpful in depicting the nature of cord compression such as myelomalacia, edema, demyelination or cyst formation and root sleeve involvement.
Behçet's Disease Presenting with Acute Transverse Myelitis: MRI Findings and Review of the Nosology
Authors: Sanal H.T. , Bulakbasi N. , Kocaoglu M. , Tayfun C.
Published: April 2015

Spinal cord involvement, either isolated or together with brain, in Behçet's disease (BD) has been reported. In these cases the existence of the disease was previously known or the classical triad of disease such as oral and genital ulcers with uveitis/iritis was present. Here we describe a 22-year-old man in whom acute transverse myelitis diagnosed with MRI was the first finding of BD.
Anterior Medial Transoral C2 Vertebroplasty
Authors: Callari G. , Vallone S. , Boraso F.
Published: April 2015

We present the case of a 63-year-old man with a C2 metastasis and a life expectancy of a few months who was independent at the time of diagnosis. In accordance with oncologists and radiotherapists, under antibiotic prophylaxis and general anesthesia, C2 vertebroplasty with an anterior medial transoral approach was performed, followed by radiotherapy. A satisfactory clinical result was obtained consisting in pain relief and avoidance of progression to vertebral collapse and spinal cord compression. We suggest that vertebroplasty should be performed even in compromised patients with a short life expectancy with a C2 metastasis difficult to access from a technical point of view.
Recurrent Cerebral Fat Embolism Due to Pleural Irrigation: Fat Density Lesions on CT
Authors: Yilmaz A. , Kurt S. , Sarikaya B. , Firat M. Murat , Ocal S. , Yeginsu A.
Published: April 2015

Fat embolism syndrome is a rare, but life-threatening problem and is usually associated with severe trauma. Neurological symptoms are variable, and the clinical diagnosis is difficult. We describe a patient with fat density lesions on cranial CT sections and discuss the etiopathogenesis of cerebral fat embolism (CFE) in this patient who does not have a history of long bone fracture, but metastatic lung disease and empyema. This is probably the first case report of CFE secondary to pleural irrigation of empyema with demonstrative CT findings.
Spontaneous Resolution of Bilateral Superior Ophthalmic Vein and Cavernous Sinus Thrombosis
Authors: Shankar J.J.S. , Srikanth S.G. , Kovoor J.M.E. , Vasudev M.K. , Sinha S.
Published: April 2015

Superior ophthalmic vein thrombosis is uncommon, and bilateral superior ophthalmic vein thrombosis is rarer still. The resolution of bilateral superior ophthalmic vein thrombosis takes a long time. The spontaneous resolution of bilateral superior ophthalmic vein thrombosis is not known and not reported in the literature so far. Here we present MRI of bilateral superior ophthalmic vein thrombosis and its spontaneous resolution.
Treatment with Double Neuroform2 Stent Deployment of a Ruptured Fusiform Internal Carotid Artery Aneurysm
Authors: Cho Chun-Sung
Published: April 2015

The Neuroform stent is the first microcatheter delivered stent designed specifically for the treatment of cerebral aneurysms. Recently, some reports on unconventional uses of the Neuroform stent have provided intelligent technical solutions to difficult endovascular cases. A 43-year-old man presented with severe headache. Imaging studies revealed subarachnoid hemorrhage and a fusiform vessel dilatation with a small aneurysm arising from the communicating segment of the left internal carotid artery. We report here the case of a double Neuroform2 stent without coiling within a ruptured fusiform aneurysm of the internal carotid artery.
Castleman's Disease: Unilateral Cervical Involvement and Imaging Findings
Authors: Dogan N. , Hakyemez B. , Topal N.B. , Atahan S. , Parlak M.
Published: April 2015

Castleman's disease is an idiopathic lymphoproliferative disorder characterized by massive enlargement of lymph nodes. It may have a unifocal or multifocal presentation; the mediastinum is the most common site (70%). Patients with cervical disease usually have unifocal involvement (90%). The main problem posed by cervical Castleman's disease is that it should be considered in the differential diagnosis of cervical tumors. This report describes a patient who had unifocal Castleman's disease on the left side of the neck, and discusses the differential diagnosis with findings on magnetic resonance imaging, computed tomography and ultrasonography.
Brain MRI in Fetuses with Cardiac Tumours
Authors: Jurkiewicz E. , Bekiesińska-Figatowska M. , Romaniuk-Doroszewska A. , Dangel J.
Published: April 2015

Tuberous sclerosis complex (TSC) is an autosomal dominant multisystem disorder which affects the skin, brain, heart and other organs. It is caused by mutations of two genes: TSC1 (on chromosome 9q34) or TSC2 (on 16p13.3). 70% of cases are sporadic with new mutations. This study aimed to highlight the utility of prenatal MRI as an adjunct imaging modality in the diagnosis and prognosis of tuberous sclerosis complex. Prenatal ultrasound and magnetic resonance imaging were performed in seven fetuses at a gestational age of 30, 32, 34 and 35 weeks using a 1.5 T MRI scanner. SSFSE,T2- and FGRE/T1-weighted images were obtained in axial, coronal and sagittal planes. Postnatal MRI was performed in two cases. Intracardiac tumors (rhabdomyomas) were revealed on ultrasound in all fetuses. On sonographic examination the brain tissue appeared normal in all cases. Brain MRI revealed focal low-signal-intensity lesions, localized along the walls of the lateral ventricles of five fetuses. Another hypointense lesion was seen at the grey/white matter junction in one case. Brain MRI of two fetuses was normal. The diagnosis of TSC was established in five cases. Postnatal MRI in two cases confirmed prenatal findings. MRI allows more complete evaluation of the fetus and helps to determine the diagnosis and prognosis in cases of TSC. The use of prenatal MR imaging in addition to prenatal sonography has the potential to improve genetic counseling and prenatal diagnosis of patients with tuberous sclerosis.
Increased Oxidative Stress and Xanthine Oxidase Activity in Human Ruptured Cerebral Aneurysms
Authors: Li Li , Yang Xinjian , Dusting Gregory J , Wu Zhongxue , Jiang Fan
Published: April 2015

Recent studies have suggested that oxidative stress may be involved in the development of arterial aneurysms. Xanthine oxidase is implicated in the generation of reactive oxygen species under pathological conditions in the cardiovascular system, and increased xanthine oxidase activity has been reported in human aortic aneurysms. We, therefore, studied the changes of xanthine oxidase activity and oxidative stress in human ruptured cerebral aneurysms. Six cerebral aneurysmal samples were obtained during surgery. Normal arteries of the similar size (one superficial temporal artery, four uterine arteries and three right gastroepiploic arteries) were used as controls. The xanthine oxidase activity was measured with a commercial assay kit, and its expression was localized by immunohistochemistry. The xanthine oxidase activity was significantly increased in aneurysms by 4.1 fold (P<0.05) compared to control arteries. This was accompanied by an elevated malondialdehyde (MDA) level (8.3±5.1 versus 2.9±0.7 nmol/g protein, mean ±SD, P<0.05), a marker of oxidative stress. Immunohistochemistry established that xanthine oxidase was mainly expressed in infiltrating inflammatory cells. Our study indicates that xanthine oxidase may have an important role in the increased oxidative stress in ruptured cerebral aneurysms. Further studies are needed to clarify the role of XO-derived reactive oxygen species in the development and rupture of cerebral aneurysms.
Surgical Treatment of Cervical Arteriovenous Fistula in a Patient with Neurofibromatosis Type 1
Authors: Guzel A. , Tatli M. , Er U. , Kazanci A. , Ozturk H.M. , Belen D.
Published: April 2015

Vasculopathies are frequently associated with neurofibromatosis type-1, and they are generally occlusive or stenotic type lesions. Vertebral arteriovenous fistula (AVF) is quite rare in neurofibromatosis type 1 patients. They can be treated with surgical excision or endovascular occlusion. We describe a surgically treated cervical AVF in a neurofibromatosis type 1 (NF-1) patient and discuss the selection of the patient for the surgery. Although endovascular occlusion is the first line treatment option for cervical AVFs, some selected cases can be successfully treated by surgery. Surgery should be considered as a treatment option in spite of its risks, especially for cervical AVF which is associated with fibromuscular system diseases like NF-1.
Persistent Hypoglossal Artery Associated with a Ruptured Ipsilateral Posterior Inferior Cerebellar Artery Aneurysm
Authors: Uysal E. , Velioglu M. , Kara E. , Albayram S. , Islak C. , Kocer N.
Published: April 2015

A rare case of persistent hypoglossal artery in conjuction with a ruptured aneurysm at the left proximal posterior inferior cerebellar artery (PICA) is presented. A ruptured PICA aneurysm was successfully treated by endovascular occlusion of the aneurym with coiling.
Diffusion-Weighted MRI of Van Der Knaap Leukoencephalopathy
Authors: Anik Y. , Anik I. , Demirci A.
Published: April 2015

An eight-month-old girl was admitted with signs and symptoms of deterioration of motor functions. Cranial MRI demonstrated widespread bilateral increased signal of cerebral white matter on T2-weighted images accompanying bilateral cyst-like structures at the subcortical location of frontal and parietal lobes and bilateral cysts at the temporal lobes. On diffusion MRI, increased diffusion with high ADC values were detected. The patient was diagnosed as an MLC subtype of Van Der Knaap Leukoencephalopathy with clinical and radiological findings. Cranial MRI and diffusion MRI findings are discussed in this paper.
Efficacy of in vivo31Phosphorus Magnetic Resonance Spectroscopy in Differentiation and Staging of Adult Human Brain Tumors
Authors: Bulakbasi N. , Kocaoglu M. , Sanal H.T. , Tayfun C.
Published: April 2015

The aim of this study was to evaluate the efficacy of 31P magnetic resonance spectroscopy (31P-MRS) in the differentiation and staging of brain tumors. Fifteen volunteers and 44 patients with brain tumors (14 meningiomas, 13 low- and 17 high-grade gliomas) were prospectively evaluated by 31P-MRS. The pH (r=0.493, p<0.001), [Mg+2] (r=0.850, p<0.001) PME/α-ATP (r=0.776, p<0.001), PDE/α-ATP (r=-0.569, p<0.001) and (PCr+β-ATP)/Pi ratios were well correlated with tumor differentiation. High-grade gliomas had significantly higher pH (r=0.912, p<0.001) and [Mg+2] (r=0.855, p<0.001) and PME/α-ATP (r=0.894, p<0.001) ratio, and lower PCr/α-ATP (r= −0.959, p<0.001), Pi/α-ATP (r= −0.788, p<0.001) and PDE/α-ATP ratios (r=−0.968, p<0.001) than those of low-grade gliomas. Changes in 31P-MRS parameters by the degree of malignancy are good indicators of increased anaerobic metabolism and hypoxia of tumoral tissue to compensate intratumoral energy deficiency. 31P-MRS parameters are very useful for grading and differentiation of brain tumors.
Transarterial and Transvenous Embolization of a Tentorial Dural Arteriovenous Fistula
Authors: Jiang Chuhan , Lv Xianli , Li Youxiang , Wu Zhongxue
Published: April 2015

Various treatments of tentorial dural arteriovenous fistulas have been assessed, but there are only two pertinent literature reports on percutaneous transvenous coil embolization. We describe the case of a patient with tentorial dural arteriovenous fistula coiled transvenously.
The Quantification of Cerebral Blood Flow by Phase Contrast MRA: Basics and Applications
Authors: Guo Gang
Published: April 2015

Phase-contrast magnetic resonance (PCMRA) flow quantification can determine vascular velocities and volumetric flow rate (VFR) non-invasively for in vitro and in vivo studies. Recently, the increasing power of MR imaging units and the reduced time for data acquisition and post-processing have led to an increasing number of investigations on the use of phase-contrast flow measurements as an additional source of quantitative functional information in MR imaging. In addition, PCMRA can be added to morphologic MRI sequences, offering the option to correlate flow to morphology based on data generated during one examination. This review discusses the basics of phase-contrast imaging, describing the errors and avoiding methods associated with PCMRA, providing guidelines for flow measurement and data analysis, and presenting the current clinical cerebral applications.
Hydrovenous Disorder in Vein of Galen Aneurysmal Dilatation: Special Focus on Tonsilar Prolapse
Authors: Iizuka Y. , Suzuki M. , Komura S. , Shimoji K. , Tsutsumi Y. , Konishi Y. , Kaneko K.
Published: April 2015

We analyzed five cases of vein of Galen aneurysmal dilatation (VGAD) and 12 cases of vein of Galen aneurysmal malformation (VGAM) using sagittal T1-weighted images. Tonsilar prolapse (TP) was confirmed in three cases, which were all VGAD. Two of these cases were treated by endovascular procedures. In one of these two cases, elevation of TP was observed after intervention. There were no signs of TP in the control group of 12 VGAMs. Venous hypertension interferes with cerebrospinal fluid (CSF) resorption resulting in increased brain fluid. TP frequently develops in high flow AVFs and is reversible if therapeutic intervention is performed by an experienced clinical team when appropriately indicated. We consider that TP in VGAD is mainly the result of cerebellar swelling due to chronic venous hypertension.
Morphological MRI and 3D Myelocisternography MRI in Spontaneous Intracranial Hypotension
Authors: Lupo F.A. , Paladini A. , Sticchi G. , Lupo P.
Published: April 2015

Spontaneous intracranial hypotension (SIH) is a polyhedric syndrome whose common denominator is postural headache. We describe four cases of spontaneous intracranial hypotension, their clinical-iconographic aspects, and emphasize the use of morphological MRI in the diagnosis and follow-up of this condition. In addition, we propose 3D myelocisternography MRI as a further contribution in cerebrospinal fluid losses causing postural headache.
Massive Peripheral Nerve Hypertrophy in a Patient with Chronic Inflammatory Demyelinating Polyradiculoneuropathy
Authors: Riccioli L. Albini , D'Agostino V. , Marliani A.F. , Leonardi M.
Published: April 2015

We describe a male patient with chronic inflammatory demyelinating polyradiculoneuropathy presenting extensive diffuse hypertrophy of the nerve roots of peripheral nerves. Since adolescence the patient has had a slow and progressive mainly distal loss of sensitivity and muscle weakness in all four limbs. He presented with diffuse muscle atrophy with enlarged palpable nerve trunks. Electromyography disclosed impaired sensory and motor responses in the bilateral median nerves and the right ulnar nerve. CSF examination showed elevated protein content, while MR scans depicted extensive hypertrophy of the spinal nerve roots. The patient benefitted from corticosteroid treatment.
Temporary Balloon Occlusion Test of the Left Vertebral Artery Using Parenchymography as Tolerance Predictor
Authors: Guimaraens L. , Cuellar H. , Sola T. , Vivas E.
Published: April 2015

Temporary balloon occlusion is used as tolerance predictor in patients undergoing vascular occlusion with the aid of clinical assessment during a 30–40 minute temporary occlusion. Several other techniques have been used to help predict each patient's tolerance. Digital cerebral parenchymography (DCP) was originally described to improve our analysis of brain perfusion during ischemic events. We report a case using DCP as tolerance predictor in a patient undergoing sacrifice of the left vertebral artery.
Endovascular Management of Multiple Cerebral Aneurysms in Acute Subarachnoid Hemorrhage Associated with Fenestrated Basilar Artery
Authors: Lv Xianli , Li Youxiang , Liu Aihua , Wu Zhongxue
Published: April 2015

Aneurysms arising from the fenestration of the basilar artery are rare. We describe a patient with two aneurysms originating from the fenestration of the basilar artery and the middle cerebral artery. Endovascular treatment with detachable platinum coils was performed, and two aneurysms were cured at the same time. Endovascular treatment of aneurysms associated with fenestrated basilar artery appears to offer advantages over traditional open surgical techniques.
Prognostic Impact of Magnetic Resonance Perfusional Study in Cerebral Metastases Treated with Radiosurgery
Authors: Conti G. , Aprile I. , Armadori M. , Ottaviano I. , Ranaldi A. , Ottaviano P.
Published: April 2015

Radiosurgery arrests metastatic growth by means of vascular thrombosis that causes tumor necrosis. We therefore evaluated whether tumor hypervascularization (studied with perfusional magnetic resonance sequences) is a positive prognostic factor predicting radiosurgery outcome. Twenty-four metastases were studied before radiosurgery with perfusional MR and then post therapy clinical and morphological status was evaluated. The group of lesions responsive to radiosurgery had the highest mean rCBV value (23.3) in comparison to the non responding lesions (14.7) with a statistically significant difference (p<0.005). High vascularization for radio-treated metastases was a positive prognostic factor because the radiosurgery thrombosis effect was more effective. Pre-treatment MR rCBv evaluation is a useful tool to establish metastatic response to radiosurgery.
Dysembryoplastic Neuroepithelial Tumor of the Brainstem
Authors: Baiamonte V. , Piccoli F. , La Bella V.
Published: April 2015

Dysembryoplastic neuroepithelial tumor (DNT) is a clinically benign stable lesion, most frequently located in the temporal and frontal lobes, often responsible for epilepsy in young adults. We describe an unusual case of DNT in the brainstem of a 45-year-old woman. Brain MRI showed a multicystic-like lesion localized in the left inferior pons, involving the ipsilateral cerebellar peduncle and partially dislocating the fourth ventricle. The specific pattern of MRI and CT appearance of DNT and its benign course (our patient is clinically stable with unchanged MRI images at two year follow-up) may help differentiate this tumor from other lesions, i.e. ganglioglio-mas and glioneural malformations.
Primary Intradural Extramedullary Ependymoma: Imaging Findings and Review of the Literature
Authors: Fasoli F. , Minniti G. , Serio N. , Di Stefano D. , Romano A. , Ferrante M. , Fantozzi L.M. , Bozzao A.
Published: April 2015

We describe a 32-year-old woman who presented with progressive dorsal back pain. Neither sensory nor motor deficit was reported. Magnetic resonance imaging (MRI) of the dorsal spine revealed a primary intradural extramedullary lesion with severe spinal cord compression. No other lesion was found in the central nervous system. During surgery an intradural extramedullary tumor was found without medullary infiltration and a total removal was achieved under microscopic guidance. The histological diagnosis revealed a benign extramedullary ependymoma. The patient recovery completely after surgery and at a follow-up of 24 months MRI showed no evidence of tumor recurrence. Ependymoma should be taken in account in the differential diagnosis on intradural extramedullary tumours.
Distal Anterior Cerebral Artery Aneurysms: Endovascular or Surgical Treatment?
Authors: Saponiero R. , Toriello A. , Locatelli G. , Pugliese N.D. , Napoli A.N. , Napoli M. , Siani A. , Cuomo G. , Panza M.P. , Narciso N. , Posteraro L.
Published: April 2015

Cerebral aneurysms are occasionally associated with anomalies of the cerebral arteries. Most reports on anomalies of the anterior cerebral artery have been concerned with hypoplasia, fenestration and the infra-optic course of the A1, variant A1 perforators or Heubner's artery, multi-channeled anterior communicating artery, and azygos anterior cerebral artery. Distal anterior cerebral artery (ACA) aneurysms are known to have a poor clinical course and prognosis compared to other supratentorial aneurysms. The presence of the unpaired, distal, postcommunicating (A2) segment of the ACA is very rare in adults. We describe a patient with a ruptured aneurysm arising from the proximal end of the azygos ACA, first surgically treated with clipping and then with endovascular coiling. A 37-year-old woman at 34 weeks' gestation was transferred to our emergency room with sudden onset of severe headache and vomiting. Computed tomography (CT) revealed subarachnoid hemorrhage in the basal cisterna and the sylvian and interhemispheric fissures. Cerebral angiography showed an azygos ACA, a saccular aneurysm at the junction of the azygos ACA and the right A1 segment. A right fronto-temporal craniotomy was performed in the day of admission, and the neck of the aneurysm was clipped. One year later, an angiographic control examination revealed a regrowth of the aneurysm. The patient underwent endovascular treatment with coiling. Aneurysms of the azygos ACA are rare and their pathogenesis and course are still a matter of discussion. Developmental abnormalities or dynamic vessel wall stresses can explain the high incidence of aneurysms in these cases. The association of a rare anatomical variant with an aneurysm in the same location may suggest an embryogenesis alteration in the Willis circulation.
Prenatal MRI Diagnosis of Vein of Galen Malformation
Authors: Bekiesinska-Figatowska M. , Jurkiewicz E. , Pedich M. , Furmanek M. , Walecki J. , Romaniuk-Doroszewska A.
Published: April 2015

This is a short comment on the article by Y. Iizuka et Al “Anatomical subcategorization for pediatric Vein of Galen aneurysmal dilatation” (The Neuroradiology Journal 2007, 20: 551–561).
Type a Niemann-Pick Disease
Authors: D'Amico A. , Sibilio M. , Caranci F. , Bartiromo F. , Taurisano R. , Balivo F. , Melis D. , Parenti G. , Cirillo S. , Elefante R. , Brunetti A.
Published: April 2015

We describe three patients with type A Niemann-Pick disease (NPD-A). NPD-A is an autosomal recessive neuronal storage disease classified among the sphingolipidoses, characterized by accumulation of sphingomyelin in various tissues and in the brain. Magnetic Resonance imaging (MRI) of our three patients showed a marked delay of myelination with frontal atrophy. Few descriptions of this MRI pattern of delayed myelination have been published to date.