bluuebunny/crossref_metadata_2025 huggingface dataset:
Case Report of Congenital Muscular Dystrophy, Frontal Lissencephaly and Temporal Pachygyria
Authors: Doni D. , Cappellini A. , Ferrari E. , Grimaldi M. , Zorloni C. , Paterlini G. , Tagliabue P.
Published: April 2015

The etiology of isolated lissencephaly is related to genetic defects but a minority of cases is associated with a vascular or an infection insult. We report a case of a preterm infant, small for gestational age (birthweight < 3° centile) associated with microcephaly. The first examination at birth revealed joint deformities such as arthogryposis and neurological abnormalities. Parents were not consanguineous.

The brain ultrasound scan raised the possibility of the suspect of lissencephaly and the cerebral MR imaging showed a frontal temporal absence of gyration with a smooth and thin cortex, enlarged subarachnoid spaces and white matter hypomyelination. The muscle biopsy specimen was studied and immunohistochemical method demonstred an abnormal glycosylation of the protein α-dystroglican in some muscle fibers. The chromosomal analysis was normal and we also excluded the classical type I lissencephaly associated with the 17 chromosome.

The autopsy confirmed lissencephaly in the frontal and the parietal brain regions and pachygiria in the temporal ones. Moreover macroscopic examination demonstred the muscular atrophy and the severe arthrogryposis. So the patient had a first diagnosis of congenital muscular dystrophy and the brain has still been evaluating to search for the same histochemical pattern seen in the muscle.
Studio RM dell'encefalo di trentacinque bambini affetti da amaurosi congenita di Leber
Authors: Uggetti C. , Fazzi E. , Signorini S. , Egitto M.G. , Pichiecchio A. , Zappoli F. , Lanzi G.
Published: April 2015

There are few literature reports of MR study in children with Leber's congenital amaurosis, a severe early onset autosomal recessive retinal dystrophy. We describe the clinical and neuroradiological findings in 35 patients. Of these, 22 had a normal brain MR scan, four showed mild dilatation of the cortical sulci, two had mild optic-chiasmatic thinning, three showed aspecific white matter changes not involving the primary visual pathway and four had “molar tooth” mesencephalic malformation. Our series confirms literature findings of normal signal and morphology of the primary optic pathway. Posterior cranial fossa abnormalities, defined as rhombencephaloschisis, was associated with a clinical picture different from that of the other patients. This abnormality is encountered in different malformations associating cerebellar, ocular and renal abnormalities. MR brain study in children with Leber's congenital amaurosis is recommended not only to assess the visual pathways, but also to analyse the posterior cranial fossa and cerebellum.
Pseudotumor Cerebri dell'età infantile e adolescenziale
Authors: Erbetta A. , Estienne M. , Zibordi F. , Balestrini MR , Chiapparini L. , Ciceri E. , D'Incerti L. , Savoiardo M.
Published: April 2015

In a retrospective fashion we reviewed the clinical aspects and the neuroradiological findings in 23 young patients (mean age at the onset 9.2 year-old) affected by Pseudotumor Cerebri, examinated at our Institution in the last ten years. The syndrome is characterized by high CSF pressure value without hydrocephalus, expansive lesions or biochemical modifications of the liquor.

The aim of this study is to evaluate the importance of the neuroradiological examinations in the diagnosis of Pseudotumor Cerebri.
Empiema subdurale interemisferico in una ragazza di 15 anni
Authors: Catalucci A. , Zugaro L. , Tarquini P. , Di Giammartino D. , Bigossi F. , Lucantoni D. , Gallucci M.
Published: April 2015

The Intracranial Complications of infection of the paranasal sinuses are uncommon and subdural empyema is rarer still. Roughly half of the cases of subdural empyema are caused by sinusitis and the most common source of infection is the frontal sinuses.

MR scan is the method of choice for the diagnosis and monitoring of subdural empyema, allowing prompt institution of appropriate treatment thereby reducing mortality.

We describe a 15-year-old girl with interhemispheric subdural empyema caused by fronto-ethmoidal sinusitis. Clinical onset was characterised by high fever, severe headache, nausea, vomiting and diplopia. CT scan showed evidence of a left parafalcial hypodense collection. MR scan, especially after contrast administration, showed the exact extension and location of the interhemispheric subdural empyema, also displaying the associated leptomeningitis and fronto-ethmoidal sinusitis. Prompt medical treatment led to a remission of symptoms and sinus infection with associated leptomeningitis as documented by serial MR monitoring. However, the slow progressive increase in size of the subdural collection was deemed an indication for neurosurgical management (evacuation of the collection by ventricular drainage catheters inserted under stereotaxic control) leading to a complete resolution of the subdural empyema without neurological sequelae.
RM in pediatria
Authors: Sabatini M. , Puglielli E. , D'Emidio F. , Splendiani A. , Arrigoni G. , Gallucci M. , Masciocchi C.
Published: April 2015

We describe the anaesthesiological protocol and monitoring system for children receiving sedation or general anaesthesia during MR investigation at our hospital. Constant recourse to sedation and analgesia during diagnostic procedures in children makes non-invasive monitoring of vital parameters essential in these patients.

The use of short-acting drugs has the advantage of offering effective sedation with an increasingly low incidence of side effects.

We report the ten year experience of a single anaesthetist monitoring children undergoing MR scans. Diagnostic quality MR investigation was possible in all cases. The personal experience of a single anaesthetist optimized an effective and safe anaesthesiological protocol.
Pneumorachide cervicale
Authors: D'Emidio F. , Carafa S. , Puglielli E. , Splendiani A. , Masciocchi C. , Gallucci M.
Published: April 2015

We describe an eight-year-old girl who developed cervical pneumorachis after traumatic injury. The child presented subcutaneous and mediastinal emphysema and subluxation of the large horns of the hyoid bone disclosed by CT scan a few hours after an accidental fall with mandibular impact. The CT scan also showed a left paramedian collection of air in the spinal canal probably caused by a minor tracheal lesion with passage of air in the posterior mediastinum, paravertebral soft tissues and through the nerve sheaths in the extradural spine. The CT picture normalized after ten days.

The presence of air in the epidural space of the spinal canal is more commonly associated with epidural abscess, disc degeneration and sometimes lumbar puncture. Some literature reports describe cases of pneumorachis secondary to pelvic trauma.
La valutazione RM della sclerosi tuberosa
Authors: Uggetti C.
Published: April 2015

The myriad brain abnormalities characterising tuberous sclerosis are all the result of the same pathogenetic mechanism, a genetic impairment of the germinative matrix. MR scanning plays a major role in the diagnosis and follow-up of patients who must be monitored up to the age of twenty to rule out the possible neoplastic transformation of subependymal nodules. MR scans should also be offered to the parents of children with tuberous sclerosis to disclose asymptomatic subjects. Starting from a total of 36 scans in a personal series of 24 patients, we describe the best sequences for brain investigation, the different MR findings and their changes over time with possible clinical correlations.
Follow up Study of Embolized Brain Aneurysms
Authors: Raffi L. , Simonetti L. , Cenni P. , Agati R. , Bacci A. , Leonardi M.
Published: April 2015

We describe our experience at the Neuroradiology Service, Bellaria Hospital, Bologna, using three-dimensional time-of-flight magnetic resonance angiography (3D TOF MRA) with Maximum Intensity Projection reconstructions without gadolinium administration in 50 asymptomatic patients with saccular cerebral aneurysms following microcoil embolization.

3D TOF MRA follow-up was done one, three and six months and one year after treatment. The first MRA was compared with the angiogram obtained immediately after treatment and served as a reference for subsequent MRA monitoring.

Angiographic follow-up was only undertaken in some patients, when a flow signal was present in the coil mesh or neck region or in the aneurysmal sac, and in relation to the degree of occlusion obtained by embolization.

Eight out of the 50 patients underwent redo embolization after MRA disclosed recanalization confirmed by angiography. 3D TOF MRA was fast, straightforward and very useful in the short and long-term follow-up of patients after embolisation, proving a first choice method with a good correlation between the reference angiogram and MRA findings. 3D TOF MRA was also valid in the diagnosis of clinically significant findings confirmed by angiography in all cases, thereby selecting patients requiring further diagnostic investigation by angiography and possible redo embolization.
Pharmacological Mechanisms Underlying Oxygen-Ozone Therapy for Herniated Disc
Authors: Simonetti Luigi , Raffi Luisa , Cenni Patrizia , Agati Raffaele , Leonardi Marco
Published: April 2015

In the light of our present knowledge, pain caused by nerve root compression should be deemed a symptom of multifactorial origin in which the neural and perineural inflammatory reaction and its biohumoral mediators play a major role, flanked by venous stasis due to mass effect on the perineural circulation. Nerve compression appears to play an adjuvant role by generating nerve conduction abnormalities due to fibre demyelination with a direct or indirect anoxic-ischaemic mechanism.

As pain is multifactorial, ozone may also have a multifactorial pharmacological effect alleviating disc compression by shrinkage and triggering pro-fibrosing mechanisms in the herniated disc thereby counteracting the inflammatory cascade of biohumoral and cell-mediated components and improving the hypoxic status linked to arterial compression and venous stasis. Lastly, ozone may have a reflex therapy effect (“chemical acupuncture”) breaking the chain of chronic pain stimulating anti-nociceptor analgesic mechanisms.
Comparison of Cervical Cerebrospinal Fluid Flow Quantification between Healthy Volunteers and Patients with Spinal Stenosis
Authors: Cicek D. , Tali E.T. , Yucel S. , Yerli H. , Ercan N.
Published: April 2015

We measured spinal CSF velocity in healthy volunteers and patients with spinal stenosis secondary to degenerative changes of the spine. A total of 122 subjects: 33 healthy volunteers and 89 patients with neck and shoulder pain were examined. Flow quantification was obtained using cine phase-contrast sequence and flow analysis software at C7 level. The symptomatic patients were graded into three groups according to the visual degree of stenosis. In addition, all subjects were divided into three index groups dividing the dural sac area from the cord area at C7 level in the healthy volunteers, and at the most prominent stenotic level in the patient group. Subarachnoidal space index was also calculated by subtracting the cord area from the dural sac area at the same levels. The maximum systolic velocities in front of the cord at C7 level were measured between 4.6 and 31.7 (average: 17.2 ± 7.4) cm/s in the volunteer group and 4.5 and 41.6 (average: 16.1 ± 6.8) cm/s in the patient group, whereas the maximum diastolic velocities were calculated between 3.1 to 28.5 (15.1 ± 7.5) cm/s in the volunteer group and 1.5 to 40.3 (14.5 ± 7.4) cm/s in the patients respectively. Systolic average velocities were 2.9 – 10.6 (average: 6.1 ± 2.2) cm/s in the volunteers and 1.7 – 17.8 (6.6 ± 2.9) cm/s in the patients; corresponding diastolic average velocities were 0.6 – 11.9 (4.7 ± 2,4) cm/s and 0.4 – 14,9 (4.9 ± 2.8) cm/s. Systolic flow rates were 17.5 – 82.6 (34.3 ± 10.7) ml/min in the volunteers and 5.5 – 104.2 (36.0 + 19.5) ml/min in the patient group whereas diastolic flow rates were 3.5 – 78.4 (29.0 ± 15.1) ml/min and 1.6 – 75.6 (26.2 ± 15.4) ml/min. No statistically significant difference was found between the CSF flow patterns, CSF velocities and flow rates at the C7 anterior subarachnoid space in healthy subjects and patients with spinal stenosis.
Leukocoria: Clinical and Neuroradiological Findings
Authors: Galluzzi P. , Hadijstilianou T. , Venturi C.
Published: April 2015

Leukocoria is a whitish pupillary reflex resulting from retrolental abnormality. Leukocoria presents in childhood, and is an important alerting sign of intraocular pathology. In particular, leukocoria is the most common presenting sign of retinoblastoma. Neuroradiological examinations may help in the differential diagnosis between retinoblastoma and simulating lesions, such as persistent hyperplastic primary vitreous, Coat's disease, retinopathy of prematurity, etc. Close interdisciplinary collaboration between neuroradiologist and ophthalmologist is essential to provide accurate early diagnosis and proper treatment.
Special MR Techniques for Brain Imaging of Multiple Sclerosis
Authors: Sardanelli F. , Cotticelli B. , Fausto A. , Quarenghi M. , Menicagli L. , Schiavoni S. , Parodi R.C.
Published: April 2015

Standard MR techniques for brain imaging of multiple sclerosis (unenhanced SE or fast-SE T1-weighted and dual-echo, i.e. proton density- and T2-weighted, sequences; Gd-enhanced SE T1-weighted sequences) give important information on natural history, lesion load and inflammation in multiple sclerosis. We show here the use of special MR techniques to: detect more supratentorial lesions (fluid-attenuated-inversion-recovery); increase number and contrast-to-noise ratio, i.e. conspicuity, of enhancing lesions after Gd injection (magnetization transfer, fat saturation, image subtraction, high spatial resolution, double-triple contrast dose and delayed scan); and obtain information on myelin status (diffusion-weighting).
Focal Area of Contrast Enhancement at the Third Cranial Nerve Emergence Related to Parainfective Neuritis in an 18-Month-Old Girl
Authors: Iaiza F. , Zanardi R. , Bordin E. , Biasizzo E. , Comici A. , Sacher B.
Published: April 2015

We report the case of an 18-month-old girl who presented a complete III right cranial nerve paralysis which disappeared spontaneously in approximately three weeks without any medical therapy. Magnetic Resonance (MR) investigation performed three days after paralysis onset showed a focal area of contrast enhancement at the third cranial nerve emergence. MR performed three months later, with an absence of symptoms, showed a less evident but persistent contrast enhancement at the cranial nerve emergence. We briefly discuss the causes of inflammatory nerve involvement since a parainfective cause of nerve paralysis was implicated.
Pediatric Intra-Fourth-Ventricular Tumors: MR Imaging Findings with Emphasis on Features Indicating Likely Histological Diagnosis
Authors: Wei G.Q. , Huan Y. , He H.D. , Yang C.M. , Ge Y.L. , Zhao H.T. , Liu Y.L.
Published: April 2015

The fourth ventricle is one of the most common locations of various histological types of pediatric brain tumors. A histological diagnosis is an important aid in predicting prognosis and selecting the most appropriate treatment regimen. The purpose of this study was to determine the value of MR imaging in the diagnosis and differential diagnosis of pediatric intra-fourth-ventricular tumors (PITs). The clinicopathological data and MR findings of 23 pathologically verified cases of PITs were analyzed retrospectively with special emphasis on features indicating a histological diagnosis. There were ten females and 13 males in the study group aged from 11 months to 18 years, mean age 11 years. The main presentations were the symptoms and signs of raised intracranial pressure. Of 23 cases of PITs, there were eight medulloblastomas showing T1 hypointensity, marked enhancement, and T2 hyperintensity with a vague margin. Six astrocytomas, among which cyst formation was common, did not enhance with Gd-DTPA. No hemorrhage or calcification was demonstrated. The ependymomas (six cases) tended to expand within the fourth ventricle in a plastic-like fashion and showed hypointensity on T1WI and hyperintensity on T2WI with vague margins. Two choroids plexus papillomas appeared as isointense to hypointense masses with marked Gd-DTPA enhancement on T1WI and variable hyper- to hypointensity to CSF on T2WI. One case of epider-moid cyst was characterized by predominantly low intensity and high intensity signals on T1-weighted and T2-weighted imaging. It may be difficult to suggest a histological diagnosis on the basis of signal intensity features on MRI alone. In combination with the patient's age, anatomic localization, and morphology characteristics, MRI is of great value in the differential diagnosis of PITs.
MRI Evaluation of Mucosa-Associated Lymphoid Tissue Lymphoma of the Lacrimal Glands
Authors: Tsitouridis I. , Chondromatidou S. , Papapostolou P. , Goutsaridou F. , Sidiropoulou M. , Morihovitou A. , Koulerido A.
Published: April 2015

Mucosa-associated lymphoid tissue lymphoma has recently been defined as a distinct subtype of non-Hodgkin's lymphoma with characteristic clinicopathologic features. We describe MR imaging features of the lacrimal gland MALT lymphoma in a retrospective study of five patients. In three patients the tumor was unilateral and in two patients bilateral. An aggressive form of MALT lymphoma of the lacrimal gland was encountered in one case. No progression of the disease was noticed over a one-year-period, expect for one patient who gradually presented abdominal disease and died. Inner tumor structure, signal intensity on T2-weighted images and enhancement pattern were documented. Extension of the lacrimal lymphomas was also studied. Although MALT lymphoma of the lacrimal gland tends to be indolent, the lymphoma can spread to other sites.
MS Study on Three Cases of Cerebrotendineous Xanthomatosis Van Bogaert-Scherer-Epstein Disease
Authors: D'Amico A. , Caranci F. , Giugliano V. , De Marco A. , Briganti F. , De Rosa A. , Filla A. , Cirillo S. , Elefante R.
Published: April 2015

Cerebrotendineous xanthomatosis (CTX), or Van Bogaert-Scherer-Epstein disease, is a very rare recessive inherited disorder of biliary acids metabolism. CTX is due to a deficiency of the hepatic mitochondrial enzyme 27-sterol hydroxylase, resulting in an insufficient production of chenodeoxycholic acid (CDCA). We describe the MR brain findings of three cases of CTX with infantile onset and progressive neurological impairment, to discuss the main features of interest. The clinical diagnosis, often delayed to the third decade of life, finds confirmation in laboratory results (excessive urine excretion of biliary alcohols and increased serum cholestanol) and neuroradiologic studies. MR is the study of choice for the disease. Brain damage, is localized in the grey and white matter. The typical localization is symmetrical to the dentate nuclei that appear hypointense on SE T1, T2 and GE T2*-weighted images for calcic and hemosiderin (ferrous) deposition. The adjacent cerebellar white matter appears hypointense on T1-weighted and hyperintense on PD, T2 and FLAIR-weighted images because of necrosis, reactive astrocytosis, demyelination and axonal injuries. Our patients all showed typical MR dentate and cerebellar white matter lesions, especially the third patient. Literature reports also describe possible calcific xanthomas of choroid plexus 5, not found in our patients.
Studio RM in un caso di sordità acuta monolaterale
Authors: Schiavoni S. , Carletto F.
Published: April 2015

A64-year-old man underwent MR investigation for acute hearing loss. CT scans were also performed to study the petrous bones. T1 and T2 -weighted images disclosed a lucency without enhancement after gadolinium administration, suggesting blood in the left cochlea and vestibule. We could not ascertain the origin of the hearing loss as the patient denied recent inflammation in the oropharynx or otitis probably connected with the acute event. We entertained the possibility of labyrinthine hemorrhage.
Potential Impact of Advanced 3 Tesla Diagnostics in the Management of Patients with Brain Tumours
Authors: Leonardi M. , Agati R. , Cevolani D. , Bacci A. , Ricci R. , Riccioli L. Albini , Battaglia S. , Maffei M. , Simonetti L. , Spagnoli M. , Hacker H.
Published: April 2015

A General Electric 3 Tesla Signa Excite system was installed in the Neuroradiology Unit of Bellaria Hospital, Bologna in February 2004. In line with current legislation, we designed a clinical research project to assess the practical impact of the new device on the investigation of brain tumours, the pituitary gland, rare neurological diseases, epilepsy, multiple sclerosis and Parkinson's disease. We describe our preliminary anecdotal findings in the study of brain tumours and the potential impact of 3 T imaging on the preparation and management of neurosurgical candidates. One decisive result to emerge is that the greater awareness of the risks and difficulties entailed in surgical resection help the neurosurgeon establish a more clear-cut relationship with patients on seeking their informed consent. By understanding and accepting the risks involved, we hope to curb the increasing number of legal disputes caused by surgical complications.
Power Doppler Ultrasonography as a Screening Test in Asymptomatic Carotid Artery Stenosis
Authors: Yurdakul M. , Tola M. , Acu B. , Özdemir E. , Cumhur T.
Published: April 2015

We investigated the accuracy and efficacy of power Doppler ultrasonography (PDU) as a screening test in asymptomatic 60–99 % internal carotid artery (ICA) stenosis. 95 patients with internal carotid artery stenosis were examined with PDU prior to digital subtraction angiography (DSA). The results of PDU were compared with those of DSA as a reference standard. The average examination time of both carotid arteries using PDU was 3.25±1.25 minutes. The results of PDU and DSA showed a good correlation (r=0.79, p<0.001). PDU significantly underestimated ICA stenosis. The average difference between the results of PDU and DSA was −5 (95% CI: −8, −3). This underestimation was more marked at the level of 50–99 % angiographic stenosis. In determining 60–99% ICA stenosis, the sensitivity of PDU was 59% and its specificity was 97%. By taking into consideration PDU's underestimation, a PDU measurement of 45% was determined as the new threshold with high sensitivity which is suitable for purposes of screening. For this threshold, the sensitivity was found to be 95% and specificity 82%. The agreement between the observers in determining ICA stenosis by PDU was found to be fair to good (κ=0.48). PDU underestimates ICA stenosis, but this underestimation can be counterbalanced by taking a lower threshold. PDU is a rapid and easily performed method which has sufficient accuracy as a screening test in determining ICA stenosis.
Magnetic Resonance Imaging Characteristics of a Gliosarcoma
Authors: Bulakbasi N. , Onguru O. , Erdogan E. , Ilkbahar S. , Kocaoglu M.
Published: April 2015

In this case report, we define THE MR characteristics of a gliosarcoma surgically removed from the left cerebral hemisphere of a 67-year-old man who presented with right hemiparesis and headache. The tumor was located in the gray-white matter interface abutting the dural surface. It showed slightly high signal on T2-weighted images with hemorrhagic and necrotic components and irregular ring-like enhancement on post-contrast T1-weighted images. Apparent diffusion coefficient of the tumor was measured as 1.09 × 10−3 cm2/s. Tumoral and peritumoral cerebral blood volume (rCBV) ratios were calculated as 8.4 and 2.2, and choline/creatine ratios were 1.78 and 1.11 respectively. The tumor primarily compromised the secondary motor area and affected the left primary motor area on BOLD images. Although MR characteristics of gliosarcoma did not allow an exact differential diagnosis, they were very useful in surgical planning to decrease post-treatment morbidity.
Clinical, MR Imaging and MR Spectroscopy Findings in Cohen Syndrome
Authors: Bulakbasi N. , Ilkbahar S. , Kocaoglu M.
Published: April 2015

We describe a 20-year-old, non-Finnish man with Cohen syndrome (MIM: 216550). Besides the essential clinical and MR imaging findings including non-progressive psychomotor retardation, motor clumsiness, microcephaly, typical facial features, retinochoroidal dystrophy, myopia and thick corpus callosum, he also had infertility, pituitary hyperplasia and low-lying tentorium. No diffusion changes were recorded. MR spectroscopy (40 and 270 ms TE) revealed normal spectra.
Rationale for the Use of Magnetic Resonance with Gadolinium Administration and FAT/SAT Sequences before Spinal Interventional Neuroradiology Procedures
Authors: Bonetti M. , Fontana A. , Cotticelli B.S. , Manfrè L.
Published: April 2015

The role of CT scanning in presurgical planning for stabilisation surgery using metal implants is well-established. However, the advent of new interventional neuroradiology techniques like vertebroplasty, kyphoplasty, ozone discolysis, periganglionic and intraforaminal infiltration of ozone and/or steroids demands more accurate diagnostic assessment of the spine both for surgical planning and during follow-up. In this study we selected 140 candidates for spinal interventional procedures studying them by magnetic resonance scanning (MR) before and after treatment using T2 and T1 fat-saturation (FAT-SAT) sequences after gadolinium administration. T2 and T1-weighted fat-saturation (FAT-SAT) sequences yielded additional information with respect to standard MR investigation of the spine, improving clinical classification and accurate recruitment of surgical candidates. Additional information obtained during follow-up after surgery proved essential in planning the most appropriate maintenance therapy for these patients.
Role of Diffusion and Perfusion-Weighted MR Imaging in Differentiating Meningioma from Solitary Dural Metastasis
Authors: Yildirim N. , Hakyemez B. , Erdoğan C. , Parlak M.
Published: April 2015

In some instances conventional imaging techniques fail to differentiate meningiomas from isolated dural metastasis. This study aimed to evaluate the role of diffusion and perfusion-weighted MRI in differentiating meningiomas and dural metastasis. In this study, 14 metastasis and 26 meningiomas were involved. The imaging characteristics were analyzed using conventional MRI. Diffusion-weighted MRI was performed and ADC values were calculated from the solid components and the peritumoral edema. Perfusion-weighted MRI was performed and relative cerebral blood volume (rCBV) was calculated. Student's t test was used for the statistical analysis. Dural metastasis and meningiomas could not be differentiated by qualitative assessment of conventional and diffusion-weighted MRI. The mean intratumoral and peritumoral ADC values were not statistically significant (p > 0.05). The rCBV ratios for dural metastasis and meningiomas were 4.13 ± 2.32 and 7.32 ± 4.10 respectively and the difference between two was statistically significant (p = 0.003). Peritumoral rCBV ratios for dural metastasis and meningiomas were not statistically significant (p > 0.05). Conventional MRI findings of dural metastasis and meningiomas may overlap in some lesions. In differentiation of these lesions diffusion-weighted MRI yields no further information additional to conventional sequences. Perfusion-weighted MRI can be useful to distinguish these lesions by demonstrating high intratumoral rCBV ratios for meningiomas and low rCBV ratios for metastasis.
Metachronous Malignant Fibrous Histiocytoma of Skull
Authors: Pendharkar H.S. , Bodhey N.K. , Gupta A.K. , Purkayastha S. , Sandhyamani S. , Burathoki S.K.
Published: April 2015

Primary Malignant Fibrous Histiocytoma (MFH) of skull is a rare tumour with malignant features similar to MFH located elsewhere. Primary MFH of bone may metastasize to soft tissues or other bones. We report a case of a metachronous MFH involving the skull.
Cerebellar Mutism after Medulloblastoma Resection: Importance of MR Features
Authors: Maffei M. , Simonetti L. , Agati R. , Calbucci F. , Leonardi M.
Published: April 2015

We describe the MR features which appeared after resection of a medulloblastoma in the posterior fossa in a boy who developed postoperative cerebellar mutism. The anatomical and physiopathological factors responsible for this disorder are discussed.
Effect of Bromocriptine Therapy in Pituitary Adenoma ‘An Empty Sella’ Appearance
Authors: Purkayastha S. , Bodhey N.K. , Gupta A.K. , Kesavdas C. , Pendharkar H.S.
Published: April 2015

Prolactin-secreting pituitary adenomas are the most common type of functional pituitary tumor. Bromocriptine therapy is an effective alternative to surgery in this group of patients. We report a case of prolactinoma where the patient was put on bromocriptine therapy and after 15 months of follow-up the tumor almost regressed giving an empty sella appearance.
Thrombosed Cerebral Venous Vessel Recanalization and Radiological Control Methods
Authors: Semenov S.
Published: April 2015

The last effect of any thrombosis is recanalization. The aim of this study was to investigate the possibility of thrombosed cerebral venous vessels recanalization and the determination of optimal control methods after thrombolytic therapy. A group of 106 patients with adiagnosis of cerebral venous thrombosis after MRI, MR-angiography, ultrasound duplex scanning and CT-angiography underwent dynamic control examinations after thrombolytic therapy. MR-angiography and ultrasound duplex scanning appeared to be satisfactory and effective control methods to disclose thrombosed cerebral venous vessel recanalization. In our study venous vessels were recanalized in 15 cases (14%). The majority of cases of recanalization were revealed in the acute period of thrombosis.
Embolization of Craniofacial Vascular Malformations
Authors: Bodhey N.K. , Gupta A.K. , Purkayastha S. , Kesavadas C. , Krishnamoorthy T. , Kapilamoorthy T.R. , Thomas B.
Published: April 2015

Craniofacial vascular malformation (CVM) is a major cosmetic concern and may present as catastrophic situations like bleeding apart from the functional impairment. The treatment of CVM has been very challenging. Till the recent past, surgery was the mainstay of treatment. However, because of the torrential intraoperative haemorrhage and frequent recurrences, embolization has evolved as a major adjunct in treating these lesions. This study evaluated the efficacy of various preoperative embolization techniques in the management of CVM. A total of 94 patients (54 males, 40 females) with an age range from three months to 68 years with a mean of 42.4 years having craniofacial AVM (forehead, face, neck and scalp lesions) were treated with the various embolization techniques: Arterial route with (a) hydrogel only (b) hydrogel and gelfoam (c) gel foam only (d) nbutyl cyanoacrylate (NBCA), Venous route and direct puncture injection of NBCA. The devascularisation achieved with the transarterial route was between 80–95% with particulate agents and 95–100% with NBCA. Direct puncture embolization also resulted in near total devascularisation of the lesion. This resulted in a significant decrease in blood loss at surgery. Cure was obtained in a few patients without the need for surgery. After embolization, almost all the patients had mild pain and subtle increase in the swelling with firmer consistency. The embolization of CVM is an essential adjunct to surgery in most cases and can be curative in a few patients. Hydrogel, PVA and gelfoam are good embolizing agents with NBCA being excellent when used with direct puncture.
Bilateral Tumefactive Multiple Sclerosis Lesions
Authors: Haritanti A. , Lefkopoulos A. , Papadopoulou E. , Kouskouras C. , Hatzisavvas N. , Pashalidou M. , Taskos N. , Dimitriadis A.
Published: April 2015

Tumefactive lesions are a rare form of multiple sclerosis (MS) presentation often provoking a diagnostic dilemma with brain tumour or abscess. We describe two cases of tumefactive demyelinating MS plaques and two different approaches. In the first patient the clinical and laboratory findings were consistent with MS, a diagnosis supported by the rapid response to high-dose steroid treatment. On the contrary, atypical clinical, imaging and laboratory findings in our second patient misled us to a diagnosis of a brain tumour. The diagnosis of MS was made after histopathological examination of the excised mass. Both our patients developed a second tumor-like demyelinating mass in the contralateral and almost homologous white matter two years after their first admission to our hospital. A brief review of the imaging diagnostic approach to tumor-like MS plaques and changes appearing in the contralateral and especially in the homologous white matter of MS patients is reported.
Tirofiban Rescue in Acute Carotid Stent Thrombosis despite a Standard Antiplatelet Regimen
Authors: Oran I. , Altay H. , Parildar M.
Published: April 2015

Fifty minutes following implantation of a right internal carotid artery stent, left lower extremity paresis developed in a patient despite use of heparin, clopidogrel and aspirin. Immediate angiograms revealed partially thrombosed carotid stent, then tirofiban (a glycoprotein IIb-IIIa receptor inhibitor) was administered intraarterially into the stent. After 15 minutes, complete resolution of the thrombus was detected on repeat angiography. The patient had recovered completely at 30-day follow-up.
MRI Features of Tubercular Spinal Arachnoiditis
Authors: Purkayastha S. , Bodhey N.K. , Gupta A.K. , Kesavadas C.
Published: April 2015

Recently, there has been a significant rise in the prevalence of tuberculosis and an increase in the extrapulmonary manifestations worldwide. Diagnosis of extrapulmonary tuberculosis is often difficult. Although a positive chest radiograph or positive tuberculin skin test supports the diagnosis, negative results do not exclude the possibility of extrapulmonary tuberculosis. However, recognition and understanding of the common and uncommon radiologic findings of extrapulmonary tuberculosis can help in diagnosis. Here we describe the value of MRI in demonstration of subtle meningeal pathology in spinal arachnoiditis.
Stent-Assisted Angioplasty of Intracranial Vertebrobasilar Atherosclerosis: The Best Therapeutic Option in Recurrent Transient Ischemic Events Unresponsive to Anticoagulant Treatments
Authors: Guimaraens L. , Vivas E. , Sola T. , Izquierdo J. , Nasis N. , Soler L. , Benitez  , Leon M.A. , Miquel L.
Published: April 2015

Atherosclerotic stenosis of the posterior circulation refractory to medical treatment generally has a poor prognosis resulting in a high morbidity-mortality rate and the recurrence of ischemic events. Extracranial bypass in the vertebrobasilar system is possible but is also associated with high morbidity (3–21%) and mortality (13–55%)1,2, and has not been demonstrated to reduce the risk of stroke. Percutaneous angioplasty alone has also not shown favorable results, and further, has been associated with a remarkable number of complications. The improvement resulting from endovascular therapy has taken the treatment of this pathology to a new dimension. We describe eight patients with severe symptomatic basilar artery stenosis who, in addition to medical therapy, were treated by our service with angioplasty and stent placement. Three of them received urgent treatment. All patients suffering from severe stenosis of the basilar artery were treated by the insertion of balloon expandable stents. The degree of pre-stent stenosis was approximately 80% in all cases, and was reduced to 5–10% after the stent implant. There were no complications during treatment. There has not been a recurrence of symptoms or a new ischemic lesion during the one-year follow-up period. Endovascular therapy with a balloon expandable stent or angioplasty plus stent are presented as improved choices for treatment of patients with severe basilar artery stenosis refractory to medical treatment.
Influence of Coil Thickness on Packing, Reopening and Retreatment of Intracranial Aneurysms: A Comparative Study between Two Types of Coils
Authors: Slob M.J. , Van Rooij W.J. , Sluzewski M.
Published: April 2015

to compare packing, reopening and retreatment of intracranial aneurysms treated with two types of coils with different wire thickness and different shapes. Packing, defined as ratio between volume of inserted coils and volume of aneurysm, was calculated for 235 aneurysms, 120 treated with predominantly helical shaped coils of 0.010 inch wire diameter (GDC 10) and 115 treated with predominantly complex shaped coils of 0.012 inch wire diameter (Cordis TruFill). Aneurysm packing, reopening and retreatment during follow up were compared for aneurysms treated with either type of coils. Mean packing was significantly higher (absolute value 6.8 %, relative value 23.0 %, P<0.0001) in aneurysms treated with Cordis TruFill coils compared to aneurysms coiled with GDC 10 coils. Six months follow up angiography was available in 194 of 235 aneurysms. Reopening occurred in 22 of 99 aneurysms (22.2%) treated with GDC 10 coils and in 15 of 95 aneurysms (15.8%) treated with Cordis TruFill coils. Retreatment was performed in 16 of 120 aneurysms (13.3%) treated with GDC 10 coils and in 9 of 115 aneurysms (7.8%) treated with Cordis TruFill coils. Using complex shaped Cordis TruFill coils with a wire diameter of 0.012 inch to coil intracranial aneurysms results in significantly better packing compared to helical GDC 10 coils of 0.010 inch wire diameter. Retreatment rate was lower for aneurysms treated with Cordis TruFill coils compared to aneurysms treated with GDC 10 coils.
Percutaneous Intradiscal O2-O3 Injection to Treat Cervical Disc Herniation
Authors: He Xf. , Xiao YY. , Li YH. , Lu W. , Chen Y. , Chen HW. , Pen J. , Zeng QL. , Zhao JB. , Shen P. , Xu XL.
Published: April 2015

We evaluated the safety and therapeutic effect of treating cervical disc herniation with O2-O3 mixture injection into the intradiscal space. 58 patients with 126 herniated discs verified by MRI were selected for the study, and all patients presented the symptoms of upper limb, cervical and shoulder pain. The procedures were guided by fluoroscopy (28 cases) and by CT (30 cases). The puncture route was defined between the right common carotid artery and trachea clearance. 1∼2 ml O2-O3 mixture at 30–40 ug/mL was injected into each herniated disc space. 58 patients were followed up from three to 30 months after treatment. The therapeutic effect showed that 33 cases (56.9%) had excellent recovery, 11 cases (19.0%) had significant relief of symptoms, and 14 cases (24.1%) resulted in treatment failure. No serious complication occurred. The therapeutic method developed by using O2-O3 mixture injection in cervical intradiscal space was a safe and effective method for the treatment of cervical disc herniation.
Syntelencephaly or MIH, a New Variant of Holoprosencephaly
Authors: Antonello M. , Cappellini M. , Mortilla M. , Antonelli C. , Filippini A. , Fonda C.
Published: April 2015

We studied a case of middle interhemispheric variant of holoprosencephaly by magnetic resonance. A five-year-old child presented a mild language delay and relational disorders. The etiopathogenesis of the disorder remains controversial, the two main hypotheses being teratogenic and genetic. Magnetic resonance disclosed typical alterations (abnormal midline connection of cerebral hemispheres in the posterior frontal and parietal regions, partial agenesis of corpus callosum, absence of septum pellucidum) which allowed differential diagnosis from the other types of holoprosencephaly, namely the more typical alobar, semilobar and lobar variants.
Comparison between SSD and VR 3D-CT Reconstructions in the Evaluation of Complex Craniosynostoses
Authors: Tsitouridis I. , Papapostolou P. , Chondromatidou S. , Siouggaris N. , Goutsaridou F. , Emmanouilidou M. , Tarazi L. , Papastergiou C. , Tsandiridis C. , Kontaki T.
Published: April 2015

The craniosynostoses are serious abnormalities of infancy and childhood. The term craniosynostosis indicates a cranial or craniofacial dysmorphism characterized by skull growth disorder due to premature fusion of one or more sutures. It is a common clinical problem requiring the attention of many specialists. The suspicion is usually clinical, based on a cranial deformity. The diagnosis has always been almost exclusively radiological, due to the introduction of three-dimensional reconstruction techniques with Computed Tomography (3D-CT), including especially the Shaded Surface Display (SSD) and Volume Rendering (VR) algorithms. We examined 26 patients in our department with complex craniosynostosis of different types over a period of four years. Considering the data in the literature we analyze the role of 3D-CT and the results of our comparison between the two reconstruction methods in the diagnosis and management of craniosynostoses.
Incidental Neck Lesions in Children
Authors: Talenti E. , Carè M.C. , Toffolutti T. , Tregnaghi A.
Published: April 2015

Neck lesions are not uncommon in children and typically present with localised swelling. The neuroradiologist's goal is the diagnosis of cervical lesions as a concomitant pathological finding, especially in cases with intraspinal spread. Neck lesions can be classified in terms of etiology as congenital, inflammatory or neoplastic, but this division is not the best suited to a radiological approach. A more useful diagnostic indicator is the location of the lesion with a further classification based on its radiological hallmarks. An assessment of age distribution is also important for a correct diagnosis.
Graphic Profiles of Cerebral Perfusion in Dynamic CT Imaging of Hyperacute Ischaemic Stroke
Authors: Lupo F. , Perrone A. , Perfetto S.C. , Paladini A. , Sticchi G.
Published: April 2015

Ischaemic stroke accounts for 80% of cerebrovascular disease. It is the third commonest cause of death, the second cause of dementia and the primary cause of disability. The widespread availability of CT scanning, the speed of examination and its low cost make CT the gold standard for early diagnosis of stroke before the mechanisms of cell swelling are triggered heralding irreversible neuronal damage. CT scanning allows morphological assessment of brain parenchyma demonstrating or excluding any bleeding and direct or indirect signs of ischaemia. It also allows perfusion imaging to display the cerebral territory at risk. Our study aimed to devise a dynamic CT perfusion imaging technique for use on an ordinary spiral CT system to be combined with morphological study and head and neck CT angiography to disclose the cause of the stroke correlated to clinical findings. Eighty patients with transient and permanent clinical forms of acute ischaemic stroke were referred to our institution within 0.5 to eight hours after clinical onset of symptoms. All patients underwent standard CT scan followed by CT perfusion imaging, intracranial CT angiography, neck CT angiography and brain CT scan after contrast administration. Each patient received a 40 ml bolus of iodate contrast agent for each examination for a total of 120 ml at a concentration of 300 mg/ml. CT perfusion imaging yielded a graph obtained over a ROI centred on the lentiform nuclei showing the peak time (PT) equal to the mean transit time (MTT) and dependent on cerebral blood flow (CBF). The graphic profiles of perfusion correlated to clinical findings and intra and extracranial CT angiography MIP reconstructions demonstrated the etiopathogenesis of stroke, the vascular territory affected and the prognosis. Combined with morphological study of brain parenchyma, CT angiography and clinical findings, CT perfusion graphs offer an immediate diagnosis of hyperacute ischaemic stroke allowing prompt therapeutic decisions to improve the prognosis.
Massive Cysticercal Infestation Involving Brain, Orbit and Skeletal Muscles: A Case Report
Authors: Purkayastha S. , Bodhey N.K. , Gupta A.K.
Published: April 2015

Cysticercosis is a common parasitic disease in the tropical countries caused by Taenia solium. The diagnosis of cysticercosis is based, primarily, on typical imaging characteristics of CT scan or magnetic resonance (MR) scan, and clinical features. There are so many reports of cysticercosis in the literature involving various isolated body parts. We herewith report a unique case with imaging evidence of cysticercosis in brain, orbit and all skeletal muscles.
Spontaneous Spinal Epidural Haematoma at C 5-Th 7 Level after Spontaneous Delivery
Authors: Měchurová A. , Chrobok J. , Procházka V. , Procházka M.
Published: April 2015

We describe a patient with sudden onset (29 hours postpartum) pain originating at C-Th level of the spinal cord followed by impaired movement of all limbs. An urgent MRI of the cervical and thoracic spine was performed and showed an extensive epidural haematoma at level C5-Th7 localised dorsally from the spinal cord and inducing its compression, which was treated via hemilaminectomy and evacuation of haematoma. A subsequent MRI showed evidence of the development of myelopathy probably ischaemic in aetiology at level C6–C7 measuring approximately 7 × 3 × 17 mm. Neurologic investigation disclosed spastic paraparesis mainly in the lower limbs. The neurological deficit was improved by a six month intensive rehabilitation program. The prognosis of such a severe complication is always dependent upon the localisation of the haematoma and time between onset of the haematoma and spinal cord decompression.
CT Imaging of Neonatal Hypoglycemia
Authors: Balaji R. , Verghese J. , Chacko S. Ammu
Published: April 2015

We describe a case of a six-day-old infant with neonatal hypoglycemia with extensive brain damage. Computed Tomographic images exhibited parenchymal loss in the occipital and parietal lobes and thinning of the cortex through out the brain.
Role of Brain Perfusion Imaging (SPECT- Tc-99m HM-PAO) in Diagnostics and Follow-up in Diffuse Axonal Injury
Authors: Marks W. , Brockhuis B. , Lass P. , Wieczorek D. , Zapaśnik A. , Lasek J. , Witkowski Z.
Published: April 2015

Patients with diffuse axonal injury (DAI) may present an array of neurological and psychological symptoms. Magnetic resonance imaging (MRI) and computed tomography (CT) are clearly not sufficient to present the whole spectrum of underlying pathologies especially functional ones. The links between observed psychological changes and functional neuroimaging have not been fully established yet. Still unknown are the timing of DAI, which changes observed in different modalities (CT, MRI, SPECT) are primary (axons torn or severed at the time of injury and focal hemorrhagic lesions) or secondary (traumatic event only alter axonal function to elicit a local swelling followed by disconnection). This case report presents functional neuroimaging (SPECT- Tc-99m HMPAO) and psychological tests as a supplement to MRI and CT. Because of its sensitivity, functional neuroimaging may play an important role in the follow-up of mild DAI.
Osteoclastoma of the Sphenoid Sinus: CT and MR Findings
Authors: Bodhey N.K. , Gupta A.K. , Krishnamoorthy T. , Bhattacharya R.N. , Thomas B. , Radhakrishnan V.V.
Published: April 2015

CT and MR findings of osteoclastoma (giant cell tumor) in a rare site, the sphenoid sinus, are described in a 20-year-old female patient. CT was helpful in demonstrating the extent of the lesion and the bony destruction. In addition, MRI served to exclude the pituitary origin of the tumor by demonstrating its superior displacement.