bluuebunny/crossref_metadata_2025 huggingface dataset:
Studio neuroradiologico delle lesioni focali ischemiche nei nati a termine e correlazioni cliniche
Authors: Erbetta A. , Bernbaum J. , Zimmerman R.A. , D'Agostino J.A.
Published: April 2015

I danni cerebrali in epoca perinatale sono una delle più importanti cause di deficit neurologico nei neonati a termine. Possono essere diffusi o focali con aspetti anatomopatologici e neuroradiologici differenti a seconda del grado di maturazione cerebrale e del tipo di eziologia. Abbiamo eseguito una valutazione retrospettiva degli aspetti neuroradiologici e clinici di neonati con danni cerebrali focali, avvenuti nel periodo perinatale per processi trombo-embolici di varia eziologia.

Materiali e metodi.

La storia clinica di 21 neonati, ricoverati presso il Children's Hospital di Philadelphia (14 femmine e 7 maschi) con un danno cerebrale focale, avvenuto in epoca perinatale è stata rivista e correlata con gli esami neuroradiologici disponibili (20 RM, 1 CT).

Risultati.

L'indagine ha dimostrato infarti ischemici nel territorio dell'arteria cerebrale media in 15 neonati (9 a sinistra, 2 a destra e 4 da entrambi i lati); in 6 di questi pazienti ha dimostrato anche danni di tipo diffuso, quali la leucomalacia periventricolare (3 neonati) e alterazioni di segnale nei gangli della base (3 pazienti). In tale gruppo i fattori predisponenti sono stati, oltre a complicazioni durante il parto, cardiopatia congenita in 3 casi, sindrome da aspirazione di meconio in 2 casi. Infarti emorragici dovuti a trombosi venosa si sono verificati in 4 pazienti. In 2 casi erano presenti infarti corticali nei territori di confine. Per ciò che riguarda gli aspetti clinici, abbiamo riscontrato paralisi cerebrale e ritardo del linguaggio solo nel gruppo con danni nel territorio dell'arteria cerebrale media (12/15 e 7/15 rispettivamente) e nel gruppo con infarti venosi (3/4 e 1/4). Disturbi visivi erano presenti sono nel primo gruppo con infarti arteriosi (3/15).

Conclusioni.

I reperti neuroradiologici hanno permesso di categorizzare i danni cerebrali nei nati a termine nel modo seguenti: infarti nel territorio dell'arteria cerebrale media, con o senza danno cerebrale diffuso, infarti di origine venosa, infarti corticali nei territori di confine da ipotensione. Gli aspetti clinici sono in discreta correlazione con quelli neuroradiologici.
Tecnica DSA: Presente e futuro
Authors: Arosio G.
Published: April 2015

Digital Subtraction Angiography has been very important for advances in diagnostic and interventional procedures in Neuroradiology.

The introduction of new image intensifiers and TV chains introduction, specific computer systems and high-speed digital image processors developments, new image processing techniques for interventional new C-arm generation, pulsed fluoroscopy and new digital acquisition modes as rotational angiography are the main features of current Digital Angiography Systems.

New software is under clinical evaluation as 3D reconstruction of the brain vessels, using a set of DSA images taken around the patient during rotational angiography, and image intensifier geometrical distorsion correction for DSA stereotactic applications.
Angio-RM dei tronchi sovraortici
Authors: Anzalone N.
Published: April 2015

Several studies have been published on the usefulness of MR angiography of carotid bifurcations and epiaortic vessels. Almost all of them were carried out with the Time-of-Flight technique, most of them using the 2D acquisition modality. These studies claim a good overall sensitivity and specificity by comparison to digital subtraction angiography, Doppler ultrasound or both in the demonstration of carotid clinically relevant stenosis, with a slight overestimation of the degree of stenosis, especially in the moderate and severe groups. Unlike Doppler ultrasound, distal cervical and proximal intracranial arteries can be relatively well evaluated by MR angiography. Nevertheless, MR angiography also has limitations, among the best known, difficult visualization of the origin of neck arteries, inaccurate depiction of vessel morphology in case of complex flow and unreliable quantification of the degree of stenosis have to be mentioned.

To get the most of the diagnostic potential of MR angiography, imaging strategies and technical considerations have to be adapted to the morphological and hemodynamic particularities of the different segments of the supraaortic arterial structures.
Angio-RM in patologia cerebro-vascolare ischemica
Authors: D'Aprile P.
Published: April 2015

Magnetic Resonance Angiography (MRA) has achieved a major role in the non-invasive study of the intra and extracranial cerebral vessels. In the vascular occlusion pathology of brain, MRA with 3D-time-of-flight technique is particularly useful.

The modern approach to stroke makes provision for MRA because of the complete management of the patient. Recently the development of the variable flip, angle (TONE) and magnetisation transfer contrast techniques (MTC) have improved spatial resolution. MRA is particularly useful in the management of children with vascular pathology because of laminar flow which permits better visualization of small vessels. Only a wide knowledge of MRA and its limits and artifacts can reduce diagnostic errors.
Misura del flusso cerebrale regionale con Angio-TC ed elaborazione delle immagini
Authors: Bartolini A. , Gasparetto B. , Roncallo F. , Sullo L. , Giberti L.
Published: April 2015

An image of rCBF is generated by dividing the images of vascular volume and of intracerebral mean transit time obtained by an angio-CT sequence. This image is comparable to that obtained by Xe-CT as far as the distribution of rCBF is concerned. On quantitative grounds however, it shows larger rCBF values due to the valorization of high flow compartments corresponding to non-nutritional vessels.
Valutazione con angio-RM di aneurismi cerebrali embolizzati con spirali di Guglielmi
Authors: Aprile I. , Biasizzo E. , Lavaroni A. , Petralia B. , De Colle M.C. , Iaiza F. , Fabris G.
Published: April 2015

We performed 25 control studies in 17 patients with cerebral aneurysms embolized with Guglielmi coils (GDC), both with MR-angiography (MRA) and digital subtraction angiography (DSA). No case studied with MRA showed artifacts due to GDC. In some cases (15/25, 60%) there was a poor visualization of small vessels, distal to the aneurysm (probably caused by turbulent flow due to GDC presence).

In cases with complete occlusion (16/25) there was a good correlation between MRA and DSA. At the moment the cases of partial occlusion (9/25) are too few to express a true judgement. In conclusion MRA may become an alternative to DSA, mainly in elderly patients.
TC-3D del basicranio: Considerazioni diagnostiche e cliniche
Authors: Avataneo T. , Liboni W.
Published: April 2015

3D reformattations play an increasingly important role in the diagnosis of skull base pathological masses since they allow a direct study of bony and soft tissues. In this article we discuss usefulness of morphologic evaluation by CT and 3D-MPR in 64 patients examined for skull base tumors.

3D imaging proved to be useful, especially before surgery; owing to its multiple projections, delineating perfectly the extension and limits of the lesion.

Postoperatively time, CT allowed a good evaluation of the results obtained, permitting the study of bone grafts and the identification of tumoral portions larger than previously supposed by the neurosurgeon, warranting further therapy.
Riflessioni sulla diagnosi della diffusione meningo-encefalica di patologia infiammatoria oto-mastoidea e sinusale
Authors: Simonetti L. , Esposito F. , Capasso P. , Greco L. , Sirabella G. , Cirillo S.
Published: April 2015

Nel generale incremento di incidenza (o di riconoscimento?) della patologia infettiva ed infiammatoria cerebrale, anche le diffusioni secondarie da patologia di pertinenza otorinolaringoiatrica risultano maggiormente frequenti.

Gli autori propongono la propria esperienza su 10 casi, ponendo l'attenzione;

• sulle grandi possibilità diagnostiche della TC anche del solo interessamento meningeo;

• sull'importanza dell'integrazione con la diagnosi infettivologica su liquor;

• sul decorso nel tempo di tali lesioni alla TC, in relazione alla risposta alla terapia.
Studio neuroradiologico su 10 pazienti con distrofia neuroassonale infantile
Authors: Farina L. , D'Incerti L. , Grisoli M. , Bruzzone M.G. , Nardocci N. , Zorzi G. , Savoiardo M.
Published: April 2015

La distrofia neuroassonale infantile (INAD) è una malattia degenerativa ereditaria con esordio nel primo o nel secondo anno di vita e progressivo sviluppo di spasticità, deficit visivo e demenza. La diagnosi si ottiene con biopsia cutanea che dimostra le tipiche alterazioni costituite dagli sferoidi assonali.

Presentiamo i dati neuroradiologici di 10 pazienti, 7 maschi e 3 femmine, studiati presso il nostro Istituto tra il 1987 e il 1996.

Nove pazienti avevano 1 esame RM e 4 pazienti 2 per un totale di 13 esami RM: 12 erano stati ottenuti con apparecchio 0.5T., 1 con apparecchio 1.5T. Due pazienti hanno anche effettuato 1 esame TC; un paziente è stato sottoposto unicamente ad 1 esame TC. Il reperto più costante è la presenza di atrofia cerebellare riscontata in 8 casi su 10 e sempre associata ad una iperintensità di segnale in T2 della corteccia cerebellare; la cisterna magna e le cisterne intorno al tronco erano ingrandite in 6 casi. In 4 casi era presente un'atrofia del chiasma. Reperti più rari sono stati una iperintensità in T2 dei nuclei dentati (3 casi), della sostanza bianca periventricolare posteriore (2 casi) e del grigio periacqueduttale (2 casi). Nei 2 fratelli è stata evidenziata una iperintensità della porzione mediale dei globi pallidi. Dei 5 pazienti con controlli a distanza 3 mostravano una progressione dell'atrofia cerebellare e 2 nessuna evoluzione.

Il dato RM più costante sembra essere quindi l'atrofia cerebellare associata ad una iperintensità in T2 della corteccia cerebellare. L'assenza di questo reperto non esclude peraltro la diagnosi. La coesistenza di un'alterazione dei globi pallidi riscontrata nei 2 fratelli rappresenta probabilmente un aspetto fenotipico diverso della stessa malattia piuttosto che una malattia differente.
Dacriocistografia con risonanza magnetica con Gadolinio: Prime esperienze
Authors: Manfrè L. , Banco A. , Affronti A. , Accardi M. , Ponte F. , Sarno C. , Lagalla R.
Published: April 2015

Esistono diversi sistemi di indagine della pervietà delle vie lacrimali (sondaggio, dacrioscintigrafia, dacriografia, dacrioTC). I sistemi suddetti presentano alcuni svantaggi, quali l'uso di radiazioni ionizzanti e la mancata ottimale valutazione dei tessuti molli circostanti. Valutazioni anatomo-patologiche hanno documentato la tollerabilità del Gd-DTPA da parte delle cellule endoteliali vascolari e dell'epitelio corneale stesso. Scopo del lavoro è quello di valutare la sensibilità della RM nella valutazione del normale ed anormale deflusso lacrimale mediante istillazione per via topica nel sacco congiuntivale di Gd-DTPA.

Sono stati esaminati 6 volontari sani e 14 pazienti affetti da patologia ostruttiva delle vie lacrimali (stenosi secondaria a flogosi, mucocele, fibrosi post-chirurgica), preventivamente valutata mediante dacriocistografia o dacriocistoscintigrafia. L'indagine RM è stata effettuata mediante unità operante a 0.5T. Il mezzo di contrasto paramagnetico è stato diluito in concentrazioni dell'1% con lacrima artificiale e sono state istillate 5 gocce per sacco congiuntivale. In 4 pazienti è stata effettuata anche una incannulazione del canalicolo lacrimale inferiore.

In nessuno dei volontari sani o dei pazienti esaminati è stato rilevato alcun disturbo obiettivo o soggettivo nei confronti della congiuntiva e cornea, né irritazione oculare. Nei 6 volontari sani le sequenze T1 ponderate hanno dimostrato la visualizzazione del sacco lacrimale e delle vie lacrimali. Nei pazienti con patologia ostruttiva, in 2 casi si è dimostrata una pervietà parziale delle vie lacrimali, con impcrvietà completa nei rimanenti pazienti.

La dacriocistografia con RM ed uso del Gd-DTPA semplicemente istillato nel sacco congiuntivale costituisce una metodica innocua. In considerazione della frequente necessità di effettuare nei pazienti con patologia ostruttiva delle vie lacrimali un bilancio RM orbitario e dell'ottimale valutazione dei tessuti molli mediante RM, la dacriocistoscintigrafia per istillazione potrebbe costituire una interessante tecnica da aggiungere all'esame standard dell'orbita. La diluizione del mezzo di contrasto (1cc Gd-DTPA: 100 cc lacrima artificiale) ne minimizza peraltro le spese.
Patologia cerebrovascolare in 5 pazienti affetti da iperomocisteinemia
Authors: Chiapparini L. , Grisoli M. , Ciceri E. , Milanesi I. , Erbetta A. , Florio S. , Savoiardo M.
Published: April 2015

Elevati livelli di omocisteinemia hanno un effetto citotossico sull'endotelio vasale e interagiscono con le piastrine e con le proteine della coagulazione in senso pro-aggregante.

Numerosi deficit enzimatici congeniti del metabolismo della metionina possono causare elevati livelli di omocisteina nel plasma e determinare le numerose sindromi cliniche dell'omocistinuria associate frequentemente a lesioni vascolari ischemiche del bambino e del giovane adulto.

Anche una lieve iperomocisteinemia, causata da deficit di folati, vitamina B12 o B6 appare associata ad un maggior rischio di malattie vascolari aterosclerotiche e tromboemboliche. In questo secondo gruppo con una semplice terapia correttiva si può ottenere la normalizzazione del quadro plasmatico in una percentuale considerevole di pazienti.

Consideriamo gli aspetti neuroradiologici di 5 pazienti affetti da iperomocisteinemia.

Sono state valutate retrospettivamente le immagini neuroradiologiche (5 RM e 2 angiografie) di 5 giovani adulti (3 femmine e 2 maschi) con elevati livelli plasmatici di emocisteina, di natura carenziale (1 caso) e da deficit enzimatico (1 caso); i restanti 3 casi sono ancora in corso di definizione.

4 pazienti presentavano infarti ischemici cerebrali e cerebellari di estensione variabile, a carico di territori vascolari sia di arterie leptomeningee sia di arterie perforanti. In un caso si sono verificati numerosi infarti emorragici dovuti a trombosi del sistema venoso profondo e dei seni durali.

L'iperomocisteinemia deve essere presa in considerazione nei giovani pazienti con lesioni vascolari sia in mancanza di altri fattori di rischio sia in associazione ad essi.

La diagnosi precoce è importante nei casi di natura carenziale per mettere in atto una terapia correttiva. Nei casi di accertato deficit enzimatico è auspicabile uno screening familiare.
Aneurismi arteriosi intracranici associati ad altre anomalie vascolari
Authors: Muras I. , Rispo A. , Esposito D. , Rinaldi F. , Bernini F.P.
Published: April 2015

After subarachnoid hemorrage, the first aim in performing angiographic investigation, is to recognize the cause of bleeding.

The arteriography can identify an aneurysm, the most frequent vascular malformation, but also associated vascular abnormalities. We report our experience on a study using angiographic investigation to explore intracranial aneurysms.

Our data confirme high occurrence of kinking, coiling and others vascular abnormalities of the Willis circle and of the vertebral arteries, associated with aneurysms.

This association suggests new concepts of aneurysm formation and must induce to detection of some aneurysms before rupture.
Malattia di moya-moya simulante una malformazione artero-venosa ipotalamica
Authors: Pardatscher K. , Ceccotti C. , Bartone P. , Fera F. , Silvagni U.
Published: April 2015

Left internal carotid angiography in a 35-year-old woman, with hemiplegia and aphasia due to an earlier putaminal hemorrhage, showed an unusual basket of large vessels at the base of the brain, mimicking an AVM.

The evidence of extensive transdural and leptomeningeal collaterals on external carotid and vertebral angiograms, allowed the definitive diagnosis of moyamoya disease.
Magnetic Resonance Imaging in Non-Traumatic Canalicular Peripheral Neuropathy of the Arm
Authors: Lupo F.A. , Paladini A.
Published: April 2015

The term canalicular neuropathy is applied to nerve lesions arising on nerve segments passing through the osteofibrous canals or other narrow orifices and resulting in nerve compression and entrapment. We studied 31 patients referred to us for non-traumatic canalicular syndromes in the upper limbs. After clinical, electrophysiological and morphological analysis of each case, we emphasize the role of MR imaging in establishing prognosis and selecting treatment.

Anatomosurgical specimens correlated well with MR features, whereas there was little correlation between electrophysiological severity and anatomical changes.

In summary, canalicular neuropathy is a clinical syndrome. The aim of MR investigation is to document the morphological changes which will serve to institute appropriate treatment. When patients have clinical and electrophysiological evidence of neuropathy without MR demonstration of the nerve lesion, therapy will be conservative, thus saving the cost and risk of surgery. On the other hand, when clinical and electrophysiological findings are flanked by MR demonstration of the neuropathy, the disease is known to be advanced and surgery will be indicated to prevent neurotmesis.
Calcolo trigonometrico delle coordinate stereotassiche TC nel morbo di Parkinson
Authors: Ammannati F. , Petacchi D. , Giordano G.P. , Bordi L. , Marini P. , Di Luzio A.E. Scotto , Pandolfo C. , Gronchi P. , Tesi G. , Nori A. , Mennonna P.
Published: April 2015

Nella Neurochirurgia stereotassica, ed in quella «funzionale» in particolare, è basilare la massima accuratezza nel calcolo delle coordinate che identificano la posizione della struttura-bersaglio prescelta: la precisione necessaria è dell'ordine di 1 mm.

Viene presentato un originale metodo matematico di calcolo delle coordinate di un target (T) posto ad una distanza nota da un sistema di riferimento. Quest'ultimo è costituito dal piano sagittale passante per la linea bicommissurale (CA-CP) ed il recesso infundibolare (I) del 3° ventricolo e risulta determinato in modo univoco da tre punti (CA, CP, I) le cui coordinate cartesiane sono ricavate direttamente su sezioni assiali TC.

L'accuratezza di questo metodo, intrinsecamente valido, è stata valutata preliminarmente su fantoccio.

Si tratta di una semplice e rigorosa procedura matematica che può essere adottata in Neurochirurgia funzionale, per il reperaggio di bersagli «invisibili» in interventi di tipo lesivo o di stimolazione su strutture cerebrali profonde.

Gli autori hanno impiegato questo metodo di calcolo nel trattamento del morbo di Parkinson con stimolazione cerebrale profonda in cinque pazienti.
Regression of Enlarged Lumbar Zygapophyseal Inclusions after Manipulative Therapy
Authors: Rucco V. , Basadonna P.-T. , Gasparini D.
Published: April 2015

We describe a case of low back pain (LBP) secondary to a facet syndrome, with a magnetic resonance image of enlarged zygapophyseal inclusions, which both regressed with manipulative therapy.

The role of the lumbar zygapophyseal inclusion in the pain syndrome remains uncertain, because there are no studies on these inclusions in the lumbar facet syndrome. The explanation of the role of manual therapy is also uncertain (adjusting joint subluxations, restoring bony alignment, reducing nuclear protrusion, reducing meniscoid entrapment or extrapment, decompressing facet joints, etc).

The diagnosis of classical facet syndrome LBP was made by history-taking and physical examination. The diagnosis of intra-articular enlargements was made by magnetic resonance imaging. The manipulative therapy consisted of manipulations in rotation with the spine placed in kyphosis. Before every manipulation session, spontaneous pain, pain with pressure on the zygapophyseal joint and the range of thoracic and lumbar spine motions were evaluated. After the fourth manipulation session, the patient's pain was alleviated and the enlarged zygapophyseal inclusions were no longer visible. The clinical improvement continued at the controls one and two months after the end of the manipulative therapy.

This is the first report of facet syndrome LBP with a magnetic resonance image of enlarged zygapophyseal inclusions which both regressed with manipulative therapy. It is interesting to speculate on the possible mechanisms to explain this outcome, but further studies are needed.
Le sequenze Fast Fluid Attenuated Inversion Recovery (FFLAIR)
Authors: Ferrari G. , Giovannini G. , Prinster A.
Published: April 2015

Lo sviluppo della sequenza FLAIR è nato dalla necessità di produrre immagini che mettessero bene in evidenza le lesioni situate nelle regioni periventricolari e subcorticali dell'encefalo. Tale sequenza, derivata dall'inversion-recovery, è caratterizzata da un lungo tempo d'inversione utile ad annullare il segnale del liquor e da un TE e un TR utili per produrre a livello del parenchima un segnale dipendente dal T2.

Il lungo tempo d'acquisizione della FLAIR è stato sensibilmente ridotto con l'uso della tecnica utilizzata con le sequenze fast spin-eco. La selezione e l'accoppiamento dei parametri di sequenza è oggetto di analisi e i vari produttori hanno scelto differenti ed interessanti soluzioni, privilegiando a volte un ridotto tempo d'acquisizione, altre una ponderazione T2 più marcata, con un annullamento assoluto del segnale del liquor.

L'uso di questa recente sequenza è presto divenuto d'elezione per il monitoraggio delle patologie demielinizzanti multifocali. Altri impieghi, in altre patologie, sono al vaglio di molti centri e l'ampliamento delle casistiche permetterà di comprendere quali sono le opportunità e l'efficacia offerte dall'utilizzo della sequenza Fast FLAIR.
Lumbar Free Discal Fragment Migrated Posteriorly the Dural Sac
Authors: Aprile I. , Fabris G. , Pizzolitto S. , Leonardi M.
Published: April 2015

We report a case of a lumbar free discal fragment migrated posteriorly to the dural sac. The patient was studied by CT and MR with contrast; then the surgical specimen was evaluated histopathologically to correlate MR imaging before and after contrast with the histological findings.

A free discal fragment is a fibrous and fibrochondroid intracannular mass detached from an intervertebral disc, and completely separated from it. The discal fragment may be located adjacent to the parent disc, but in other cases, the fragment can migrate far from the disc; exceptionally it can migrate behind the dural sac.

Preoperative neuroradiological assessment first of all requires definite identification of the nature of the lesion, distinguishing the fragment from other intracanal masses that may have similar features.

Some authors claim that in general the clinical symptoms caused by a free fragment are more severe than those produced by a contained herniated disc, so that the patient undergoes diagnostic examination earlier on, when the herniated fragment is not yet dehydrated.

In conclusion, it is important to establish the MR characteristics of free discal fragments to avoid confusing this condition with other intracanal lesions.
Comparison of Single-Echo T2-weighted Fast Spin-Echo and Conventional Spin-Echo MR Sequences
Authors: Sparacia G. , Angileri T. , Banco A. , Miraglia R. , Nicastro N. , Lagalla R.
Published: April 2015

We compared single-echo T2-weighted fast spin-echo (FSE) magnetic resonance imaging and conventional spin-echo (CSE) T2-weighted imaging in the detection of brain lesions of multiple sclerosis (MS).

16 patients with clinically definite MS underwent brain imaging at 0.5 T with T2-weighted single-echo fast spin-echo (FSE) and conventional spin-echo (CSE) sequences. Image analysis was performed by three of the investigators who worked together to reduce interobserver variability. Statistical analysis was performed using Student's t test to assess the difference in the contrast-to-noise (C/N) ratio of MS lesions between CSE and FSE sequences. The Wilcoxon signed rank test was used to evaluate the difference in the number of lesions between the two sequences.

There was no significant difference in the overall total number of lesions detected on FSE vs CSE (964 vs 1009, P >.05). However significantly (P = .02) more posterior fossa lesions were detected using FSE than CSE, whereas significantly (P = .002) more periventricular lesions were detected using CSE than FSE. The difference in the number of lesions in the other sites was not significant (P > .05).

There was no significant difference in the overall total C/N ratio of MS lesions between FSE and CSE sequences (11.7 ± 3.9 vs 12.6 ± 4).

Considerable time savings can be made when substituting FSE for CSE sequences in T2-weighted imaging, and this is a compelling reason to employ such sequences in clinical practice. Our results suggest that for single-echo T2-weighted imaging, FSE can replace CSE in long term monitoring especially when patient movement prevents a useful investigation and when optional scanning planes are required.
Anatomia del labirinto cocleo-vestibolare Tecnica di studio RM con sequenze 3D Turbo Spin Echo
Authors: Ettorre G.C. , D'Aprile P. , Medicamento N. , Spagnolo P. , Stefanelli M. , Carella A.
Published: April 2015

La letteratura più recente ha dimostrato l'alta affidabilità diagnostica delle tecniche RM ad alta risoluzione nello studio dell'osso temporale. Lo sviluppo di sequenze 3D Turbo Spin Echo (TSE) con sezioni fino a 0,4 mm consente un elevato dettaglio anatomico anche tridimensionale del labirinto cocleo-vestibolare. L'utilizzo di idonee bobine di superficie centrate sulla regione dell'osso temporale e l'impiego di adeguati parametri di acquisizione permette di ottenere la migliore risoluzione spaziale e di contrasto, rendendo le sequenze TSE elettive soprattutto nello studio della patologia malformativa dell'orecchio interno.

Tali sequenze sono preferibili alle Spin Echo tradizionali o alle sequenze Gradient Echo (CISS, GRASS etc.) per la minore incidenza di artefatti da suscettibilità magnetica dovuti alle innumerevoli interfaccie osso-aria dell'osso temporale e per la più elevata risoluzione spaziale e il più elevato rapporto segnale/rumore che esse offrono. Infine le sequenze TSE con TR e TF (Turbo Factor) molto alti consen-teno di ottenere un elevato contrasto liquor/nervi cranici che decorrono nel meato acustico interno.
Unilateral Hypoglossal Neuropathy: A Pictorial Essay
Authors: Roncallo F. , Turtulici I. , Arena E. , Gentile R. , Assini A. , Inglese M. , Bartolini A.
Published: April 2015

Hypoglossal nerve (cranial nerve XII) palsy is uncommon. Damage to this nerve produces characteristic clinical manifestations, of which unilateral atrophy of the tongue musculature is the most important. When these features are recognized, the radiologist, armed with knowledge of the normal anatomy of the area, can focus on each segment of the nerve in search of a cause. The hypoglossal nerve is divided into five segments: the medullary, cisternal, skull base, nasopharyngeal/oropharyngeal carotid space, and sublingual segments. Because each segment is usually affected by different disorders, localizing a lesion to a particular segment allows the radiologist to narrow down the differential diagnosis to develop the most efficient imaging strategy for the evaluation of symptoms. Both computed tomography (CT) and magnetic resonance imaging (MRI) are useful in assessing dysfunction of the hypoglossal nerve; the choice depends on the status of the patient and the preference of the radiologist.
The Open Ring or White-Matter-Crescent Pattern of Enhancement Differentiates Demyelinating Brain Disease with Tumor-Like Presentation from Infection and Neoplasm
Authors: Masdeu J.C. , Quinto C. , Olivera C. , Leslie D. , Tenner M. , Visintainer P.
Published: April 2015

Occasionally, demyelinating disease of the brain presents with ring-enhancing lesions, many times the diagnosis is not clear and demyelination has been mistaken for neoplasm or infection.

We reviewed the literature to test the specificity for demyelinating disease of an open-ring or crescent pattern of contrast enhancement present only in the white matter The open-ring sign was more common in demyelinating lesions than in infections or tumors and is helpful for differential diagnosis.

The open-ring sign was more frequent in demyelinating lesions than in infections or tumors.

The open-ring sign is often present in large, contrast-enhancing, demyelinating lesions of the brain and helps to differentiate them from tumors and, particularly, from infections.
Distinguishing Multiple Sclerosis from Cerebrovascular Disease
Authors: Du Boulay G.H. , Teather B.A.
Published: April 2015

Using defined terms, the features of MR images of brain lesions and abnormalities in multiple sclerosis (MS) and cerebrovascular disease subjects have been described by an observer blind to all other information. Analysis of the descriptions reveals some helpful differentially diagnostic features.
MRI Manifestations of Wilson's Disease and its Change in Response to Treatment
Authors: Chou M.-S. , Kuo Y.-T. , Wang C.-K. , Chen C.-Y. , Liu J.-S.
Published: April 2015

Fourteen patients with biochemically proven Wilson's disease underwent neuroimaging evaluation. The MRI manifestations could be classified as degenerative change and atrophic change. The degenerative change, most well documented on T2-weighted image, usually involves thalamus, lentiform nucleus, midbrain, cerebellum, pons and caudate nucleus. The atrophic change, which is better shown on T1 weighted image, reveals as brain stem, cerebellar or cortical atrophy as well as ventricular dilatation. Repeated MRI evaluation was performed in nine patients who had received treatment for more than 14 months, degenerative change could be reversed significantly in eight cases and another one case whose MRI was kept in normal condition, which suggest the importance of long-term management.
Neuroradiology of Cerebral Schistosomiasis
Authors: Adapon B.D. , Dioquino C.C. , Apolinar N.D. , Adapon P.H.
Published: April 2015

This paper aims to describe the brain CT scan and MRI and angiographic features of cerebral schistosomiasis to acquire a better understanding of the disease process.
A Suggested Neuroimaging Standard Utilizing Functional Radiologic Tools to Assess Late Onset of Functional Deficiencies Due to Mild and Moderate Head Trauma
Authors: Sarkar S.N. , Seastrunk J.W. , Gregory J.G. , Krusz J.C.
Published: April 2015

In this work, a radiologic standard to characterize mild head trauma is suggested by utilizing nuclear perfusion SPECT and MR Spectroscopy.
Primary Malignant Rhabdoid Tumor of the Brain Clinical, Imaging and Pathologic Findings in Five Cases
Authors: Bracard S. , Griffaton C. , Baylac F. , Taillandier L. , Moret C. , Marchal J.C. , Sommelet D. , Picard L.
Published: April 2015

We reviewed the clinical, imaging and pathologic features of primary malignant rhabdoid tumour of the brain in five patients.
Diffusion Weighted MR Imaging in Evaluation of CNS Disease
Authors: Wang A.M. , Shetty A.N. , Woo H. , Rao S.K. , Manzione J.V. , Moore J.R.
Published: April 2015

145 patients with a wide variety of CNS disease were studied. All patients had conventional spin-echo and diffusion weighted MR (b = 1000); 90% had perfusion studies and 15% had MR spectroscopy. Hyperintense lesions on diffusion weighted MR were identified in the following entities: acute stroke, CNS lymphoma, glioma, tumefactive MS, epidermoid cyst and acute dural sinus thrombosis with venous infarction. Hypointense lesions included the following: chronic infarct, arachnoid cyst, porencephalic cyst, and cystic or necrotic portions of gliomas and metastases.

MR spectroscopy showed elevated choline peak with neoplastic lesions and in tumefactive MS; elevated lactate peak was present with infarcts. There was decreased perfusion in infarcts. Diffusion weighted imaging is the most sensitive MR technique for detecting and differentiating acute infarction from TIA and other stages of infarction. Decreased diffusion was also observed in CNS lymphoma, glioma, and tumefactive MS; MR perfusion and spectroscopy may be helpful in further differentiating these entities.
Cerebrovascular Imaging with 3D MR DSA
Authors: Turski P.A. , Frayne R. , Carroll T.J. , Korosec F.R. , McKinnon S.G. , Grist T.M. , Mistretta C.A.
Published: April 2015

We have developed a time-resolved technique for acquiring high quality MR angiograms of the cerebrovascular system. The technique is known as 3D MR DSA and represents a new method for imaging the passage of a contrast agent as it passes through the vessels of interest. This is accomplished by repeatedly and rapidly acquiring data so that a series of volume images may be reconstructed every 2 s to 6 s. The advantages of our approach to contrast-enhanced MRA is that, unlike other non time-resolved techniques, 3D MR DSA does not require synchronization with the intravenous injection.
Functional MRI of Mastication
Authors: Takahashi C. , Minowa K. , Kaneko K. , Yamaguchi T. , Miyasaka K.
Published: April 2015

We tried to depict the brain activity of mastication (two types of movement) with functional MRI (FID type EPI with fat saturation on 1.5T). Thirteen of 16 volunteers (81.3%) showed proper signal changes on primary motor cortex. The active sites changed according to the type of masticating movement. We concluded that functional MRI can be used investigate the control of mastication in the CNS.
Standardization of Input Function for Quantification of Regional Cerebral Blood Flow in N-isopropyl-p-[123I]iodoamphetamine SPECT
Authors: Tsuji A. , Matsuda M. , Lee H. , Ohnishi H. , Matsuo S. , Handa J.
Published: April 2015

Quantification of regional cerebral blood flow (rCBF) using N-isopropyl-p-[123I]iodoamphetamine (IMP) and single photon emission computed tomography (SPECT) requires continuous or frequent arterial blood sampling and accurate measurement of radioactivity of many blood samples. In order to avoid these invasive and troublesome procedures, a simplified method with a single blood sampling and two SPECT scans is proposed based on the two-compartment model We tried to find the optimum time of single blood sampling for calibration of the standardized input function. There were ten subjects; four patients with cerebrovascular disease, three with brain tumor, one with head trauma, and two healthy volunteers. Their ages ranged from 25 to 74 years with the average of 56.4 years. IMP (167 MBq) was infused into the right cubital vein at a constant rate in 15 s. Following the start of IMP infusion, arterial blood was sampled from the left radial artery every 15 s for 2 min, every 30 s for the next 3 min, every 1 min for the following 5 min, and with a longer interval thereafter until 40 min after. The radioactivity of the whole blood was counted and its octanol extraction fraction was measured for each sample using the well counter. The whole blood radioactivities obtained at each time point from individual subject were averaged for all 10 subjects. The standardized input function was obtained from the product of the averaged radioactivity of the whole blood and the octanol extraction fraction at each time point. Early and late SPECT data were acquired at mid scan time of 40 min and 180 min, respectively. The rCBF was quantified by the “table-look-up” method. The difference between the standardized input function calibrated at each time point and the individual actual input function was 5.7% at most any time after 3 min and was minimal, 3.6%, at 20 min after the start of IMP infusion. These data were better than the reported minimal value of 5.3% at 9–10 min which were obtained by 1-min IMP infusion. The rCBF values figured out by the present method are well correlated with those calculated by the individual actual input function. An IMP infusion in 15 s with single arterial blood sampling any time after 3 min for calibrating the standardized input function is a practical method for rCBF quantification using IMP SPECT.
Temporal Stability of Hemodynamic Stage in Patients with Carotid Artery Occlusion
Authors: Derdeyn C.P. , Yundt K.D. , Fritsch S.M. , Videen T.O. , Carpenter D.A. , Grubb R.L. , Powers W.J.
Published: April 2015

We assessed cerebral hemodynamic status longitudinally with serial positron emission tomography (PET) studies in patients with carotid occlusion and no interval stroke. Regional measurements of cerebral blood flow (CBF), cerebral blood volume (CBV), cerebral rate of oxygen metabolism (CMRO2), oxygen extraction fraction (OEF), and mean transit time (MTT) were obtained using PET in 21 patients with unilateral carotid artery occlusion and were repeated 12 to 59 months later Hemodynamic stage was assigned based on left to right hemispheric ratios of mean quantitative values as: Stage 0, normal hemodynamics; Stage 1, increased MTT (autoregulatory vasodilatation); and Stage 2, increased OEF. Eight patients (9 paired studies) were initially categorized as Stage 0. Repeat mean hemispheric ratios remained within the range of normal value (95% confidence limits). Three patients (4 paired studies) were categorized as Stage 1. Repeat MTT ratios remained elevated while other ratios remained normal. Ten patients (11 paired studies) were categorized as Stage 2. A statistically significant increase in the CBF ratios (p ? 0.26) and decrease in OEF ratios was found (p = 0.23). A statistically significant increase in mean quantitative CMRO2 between initial and follow up examinations was observed bilaterally in patients with normal hemodynamics but not in Stage 1 or 2 patients. In selected patients with carotid occlusion and no interval stroke, the degree of hemodynamic compromise does not progress. In the subset of patients with increased OEF, both OEF and CBF improve over time.
Increased Brain Tolerance for Ischemia in Accidental Deep Hypothermia and Circulatory Arrest
Authors: Lövblad K.O. , Senn P. , Walpoth B.H. , Walpoth B.N. , Mattle H.P. , Radanov B.P. , Ozdoba C. , Schroth G.
Published: April 2015

This Swiss multicenter study evaluates the long-term outcome of survivors of accidental deep hypothermia (17–28 degrees Celsius) with circulatory arrest who were rewarmed with cardiocirculatory bypass. Deep hypothermia with circulatory arrest was found in 46 of 134 patients with accidental hypothermia. In 32 patients cardiopulmonary bypass rewarming was attempted resulting in 15 long-term survivors (6 glacier-crevasse, 1 avalanche, 7 cold air, 1 cold water exposure). None of the patients suffered asphyxia and thus hypoxic brain damage before cooling down, as often occurs in avalanche or drowning. At follow-up (mean of 7 years) medical history, magnetic resonance imaging, electroencephalography and neurovascular ultrasound were obtained. MRI with volumetric measurements of the cerebral compartments was performed in 13 of the patients. At follow-up there were no hypothermia-related sequelae impairing quality of life. Neurological and neuropsychological deficits observed in the early postwarming period had fully or almost completely disappeared. One patient displayed a potentially hypothemia related cerebellar atrophy on magnetic resonance imaging with mild clinical signs. Relevant clinical abnormalities were either preexisting or due to injuries not related to hypothermia. There were no significant differences in the compartment volumes and their quotients between the 13 patients and their controls. There was a not significant increase in the CSF in the hypothermia patients (96.4+/- 23.0 ml) when compared to the controls. Our 15 patients demonstrate that accidental deep hypothermia can be survived with no or minimal cerebral impairment even with prolonged circulatory arrest. The results of this study are encouraging considering the possibilities to increase the brain tolerance for ischemia in stroke by hypothermia using global or local application of hypothermia by endovascular transarterial or tranvenous approaches. The nonsignificant trend towards an increase in CSF in the hypothermia patients is further proof that there might exist an ischemic encephalopathy in cases of hypothermia.
Technique and Indications for Thrombolytic Treatment of Acute Venous Stroke
Authors: Tsai F.Y. , Wang A.M. , Koenigsberg R.A. , Roth T. , Dhillon G. , Yuh W.T.C.
Published: April 2015

Acute dural sinus and deep venous thrombosis may lead to venous hypertension, congestion, edema and then hemorrhage. We reviewed 41 patients with 5 different stages of imaging presentation and increment increasing dural sinus pressure.

The early Stages I or II may not need thrombolysis, but Stage III and IV should start as early as possible. Stage II may require thrombolysis if it fails in the trial of anticoagulation. All Stage V patients' results with fatality with or without thrombolysis.
Application of Diffusion-Weighted EPI to Cerebrovascular Disease
Authors: O'Uchi T. , Kuru Y. , Honda S. , Hayashi T. , Yasuda R.
Published: April 2015

Diffusion-weighted EPI using Siemens Vision was applied in 276 cases with cerebral vascular disease. Acute cerebral infarction up to 22 days after the onset showed high signal on DW-EPI. DW-EPI with 20 second acquisition time is superior to CT scan and T2WI in cases of acute cerebral infarction. Intracranial hematoma showed a homogeneous high signal within one day after the onset. Marginal low signal of the hematoma afterwards. Cytotoxic edema around the hematoma was recognized in two cases out of 25.
La Xenon-TC nella malattia di Alzheimer
Authors: Piovan E. , Puppini G. , Alessandrini F. , Pizzini F. , Zampieri P. , Foroni R. , Gambina G. , Beltramello A.
Published: April 2015

La diagnosi di malattia di Alzheimer è clinica; purtuttavia l'apporto strumentale è ritenuto importante sia per escludere altre possibili cause di demenza sia per quantificare possibili indicatori dello stato di malattia ai fini della correlazione con la gravità del quadro clinico. A tale scopo possono risultare utili l'indagine RM e le metodiche funzionali di Medicina Nucleare (SPET, PET).

Accanto a queste ultime si affianca l'indagine Xenon-TC mediante la quale nei pazienti affetti da malattia di Alzheimer si è rilevata significativa riduzione del flusso cerebrale a livello fronto-temporale rispetto ai soggetti di controllo; tale ipoafflusso è risultato prevalente in sede corticale nei pazienti “mild” mentre nei pazienti “moderate” la riduzione ha interessato anche — ed in misura più marcata — i nuclei della base e la sostanza bianca emisferica.
Dysphagia Caused by Anterior Hyperostosis of Cervical Spine
Authors: Giuffrida S. , Papotto M. , Saponara R. , Petrillo G. , De Luca S. , Milone P.
Published: April 2015

Several disorders of the nervous system and some oesophageal diseases cause dysphagia; rarely is this symptom due to anterior cervical osteophytosis. We report a case of a 64-year-old man with dysphagia for solid foods associated with hypotrophy and weakness of the right arm. Magnetic resonance imaging at the C6-C7 level showed a marked compression of the spinal cord. CT scan revealed oesophageal compression due to an anterior osteophyte at the C4-C6 level. The barium-swallow test showed oesophageal compression at the pharyngo-oesophageal junction. Several pathogenetic mechanisms are proposed: inflammatory reaction around the oesophagus, interference with oesophageal peristalsis, and interference at the pharyngo-oesophageal junction, as in our case. The severity of dysphagia is usually proportional to the dimensions of the cervical osteophyte. Medical treatment in slight cases, or surgical excision in severe cases, is suggested. Anterior cervical osteophytosis should be considered for a correct differential diagnosis as the cause of dysphagia in “neurological” patients with anomalies of the cervical spine if the symptom is unrelated to any nervous system disorder.
Interventional Neuroradiology for Cavernous Dural Arterio-Venous Fistula with Special Reference to Indications and Approach
Authors: Iizuka Y. , Maehara T. , Katayama H. , Arai H. , Sato K.
Published: April 2015

Cavernous sinus dural arteriovenous fistula (CaDAVF) occurs most commonly in middle-aged women with an onset of symptoms characterized by ophthalmic manifestations (e.g., proptosis, chemosis, diplopia, ocular paresis).

We reviewed sixteen cases of CaDAVF experienced before 1992 and 29 cases experienced after 1992. There are a variety of treatments for CaDAVF depending upon the patient's clinical symptoms. Transarterial embolization (TAE), transvenous embolization (TVE), direct packing and radiotherapy are frequently chosen alternatives. On the basis of our clinical experience, endovascular intervention by TVE via the inferior petrosal sinus (IPS) is safe and effective.

Therefore, if radiological findings verify cortical venous reflux, aggressive treatment should be performed, even when the patient presents minimum symptoms, to eliminate the risk of venous infarction and/or intracranial hemorrhage. CaDAVF is a benign entity, and the therapeutic strategy should include a detailed analysis of the angioarchitecture and careful consideration of the condition of the individual patient.
Informatizzazione di un Servizio di Neuroradiologia
Authors: Agati R. , Simonetti L. , Pozzi P. , Bacci A. , Barbara C. , Bernardi B. , Cenni P. , Giatti S. , Leonardi M.
Published: April 2015

Presso il Servizio di Neuroradiologia dell'Ospedale Bellaria è stato implementato ed avviato un sistema RIS/PACS per la archiviazione e gestione dei dati anagrafici dei pazienti, dei dati alfanumerici associati agli esami e delle immagini.

Nel progetto, che si è concretizzato in un Capitolato di gara, è stata formulata la precisa scelta di rinunciare alla documentazione iconografica su pellicola, resa possibile dall'archiviazione delle immagini su CD-R, supporto che preserva la validità legale del documento archiviato. La documentazione iconografica dell'esame viene stampata su carta e consegnata al paziente od ai reparti.

Il Capitolato di gara è stato formulato in Service, in considerazione anche della rapida obsolescenza tecnologica delle apparecchiature oggetto del Capitolato.

Il cuore del Sistema è rappresentato dalla rete Ethernet (100 Mb/s) cui sono collegati gli apparecchi diagnostici, le Workstations di refertazione e consultazione del sistema PACS, le Workstations del sistema RIS, i film digitizer dedicati alla digitalizzazione dell'archivio storico e dei precedenti dei pazienti, i Server RIS e PACS, il sistema multimediale, le stampanti su carta e pellicola.

L'adattamento del personale all'utilizzazione delle nuove tecnologie è stato rapido, verosimilmente anche in conseguenza della relativa facilità di utilizzazione dei programmi descritti (maturità della tecnologia).

Nella nostra breve esperienza l'adozione di questo Sistema ha consentito una notevole semplificazione gestionale del Servizio che si è tradotta in un miglioramento della qualità dell'assistenza al paziente, grazie alla:

disponibilità presocchè immediata dei precedenti esami del paziente, possibilità di consultazione con altri colleghi disponibilità in tempo reale delle immagini e dei referti nei reparti, essenziale per pazienti critici; drastica riduzione dei tempi di attesa del referto (da una settimana alla consegna immediata) riduzione dei tempi di attesa dei pazienti allo sportello prenotazioni, grazie all'integrazione con il CUP e alla disponibilità dei dati angrafici dei residenti a Bologna.