bluuebunny/crossref_metadata_2025 huggingface dataset:
Risposta vasomotoria cerebrale alla stimolazione con CO2 e L-Arginina
Authors: Bosone D. , Micieli G. , Zappoli F. , Argenteri A. , Marcheselli S. , Egitto M.G. , Nappi G.
Published: April 2015

È stato dimostrato che le modificazioni di velocità ematica valutabili con Doppler Transcranico indotte nella arteria cerebrale media dalla stimolazione con CO2, possono essere considerate un indicatore attendibile della riserva vasomotoria cerebrale. Tale risposta alla CO2 è significativamente ridotta in pazienti con occlusione della carotide interna e scarsa attivazione dei meccanismi di compenso emodinamico.

È stato recentemente dimostrato che anche l'aminoacido L-Arginina è in grado di indurre una vasodilatazione dei vasi di resistenza. Obiettivo della ricerca è valutare le modificazioni emodinamiche indotte a livello intracranico dalla CO2 e dalla L-Arginina in fase pre e post-operatoria ad almeno tre mesi dall'intervento di TEA, per verificare l'utilità della terapia chirurgica nel favorire il recupero della capacità vasomotoria cereberale endotelio-mediata.

Abbiamo incluso ad oggi 8 soggetti (età media 65,5 ± 6,26) con un stenosi non occlusiva almeno pari al 70% del lume della CI. Tutti i soggetti sono stati sottoposti in fase pre-operatoria a TC encefalo, Doppler Color Flow dei tronchi sovraortici, Angiografia Digitale Arteriosa, Doppler Transcranico basale e monitoraggio bilaterale delle modificazioni della velocità media di flusso indotte dalla inalazione di CO2 (RVM-CO2) e dalla infusione di L-Arginina (150 mg/Kg/i.v./30′) (RVM-Arg). Nella fase post-operatoria, ad almeno tre mesi dall'intervento, i pazienti sono stati di nuovo sottoposti al monitoraggio con le stesse modalità seguite durante la fase pre-operatoria.

Sia la RVM-CO2 che la RVM-Arg non si sono significativamente modificate nella fase pre e post-operatoria sia considerando tutti gli emisferi (M ± DS RVM-CO2 48,25 ± 23,5% e 44,6 ± 20,2%; RVM-Arg 24,2 ± 6,33% e 21,5 ± 9,7%) sia considerando solo il lato stenotico (RVM-CO2 47,7 ± 26,9% e 46,2 ± 23,5%; RVM-Arg 22,7 ± 5,64 e 21,1 ± 9,01%). Considerando il lato stenotico versus quello non stenotico nella fase pre-operatoria la RVM-CO2 non mostrava significative differenze (M ± DS 42 (23,4 e 55,6 ± 23) pur evidenziando una tendenza alla migliore riserva sul lato non stenotico; la RVM-Arg era invece significativamente migliore nel lato non stenotico (M ± DS 21,8 ± 7% e 28,3 ± 4% p=0,05). Tale debole significatività scompariva nella fase post operatoria (19,9 ± 10,5% e 22,07 ± 9,2%).

Non esiste correlazione significativa fra la reattività vamotoria indotta da CO2 e quella indotta da L-Arginina.

Nei casi finora studiati, i risultati, seppur preliminari, non sembrano evidenziare con sicurezza a distanza di 3 mesi dall'intervento un significativo miglioramento della riserva vasomotoria cerebrale, suggerendo che l'endarteriectomia in questo tipo di pazienti riduce il rischio trombo-embolico ma probabilmente non modifica sostanzialmente la situazione emodinamica antecedente.
Spettroscopia protonica RM a volume singolo con programma automatico “Probe”
Authors: Popolizio T. , Calabrese G. , Scarabino T. , Germano M. , Mingarelli R. , Ciritella P.L. , Salvolini U.
Published: April 2015

La Spettroscopia Protonica a Risonanza Magnetica (MRS) è una tecnica non invasiva che permette di misurare in vivo i livelli di sostanze chimiche differenti fornendo informazioni chimico-metaboliche sulla struttura tissutale. La recente diffusione di tale tecnica e la disponibilità ed il perfezionamento di programmi computerizzati di facile impiego ne rendono possibile l'applicazione su ampia scala permettendo l'attuazione di sofisticati studi di ricerca.

L'impiego nella pratica clinica è tuttavia ancora piuttosto scarso sia per limiti tecnici legati alla difficoltà di ottenere risoluzione spaziale e rapporto segnale-rumore ottimali, sia per i lunghi tempi di esame che la maggior parte dei programmi in uso impongono al paziente.

Nel nostro studio abbiamo utilizzato il programma PROBE (Single-voxel Proton Brain Exam), con cui è possibile acquisire spettri da singoli volumi di interesse in modo automatico, cosicché il tempo complessivo dell'esame di MRS è di circa 9 minuti, con massima tollerabilità anche da parte di piccoli pazienti sottoposti a studio in narcosi.
New Processing Methods in Functional MRI
Authors: Presciutti O. , Pelliccioli G.P. , Tarducci R. , Chiarini P. , Gobbi G.
Published: April 2015

Two processing methods of fMRI data are proposed: vector orthogonalization and Fisher transformation of correlation coefficients (cc) distribution.

The former is based on orthogonalization of vectors V (time course of signal intensity) and R (noise) to make V independent from R.

The latter is based on Fisher transformation of cc distribution. From this distribution, by usual statistical tests, it is possible to detect the values of the cc that are significantly different from the mean in order to select activated pixels.
A Radiological Approach to the Systemic and Neurologic Features of Hyperparathyroidism
Authors: Meneghello A. , Bertoli M.
Published: April 2015

Parathyroid hormone (PTH) affects the nervous system directly and indirectly. The induced pathology may present typical imaging findings in neuroradiology. The hormone controls the physiological level of blood calcium. Increased serum PTH causes pathological features in the kidneys and especially in the skeleton where most calcium is situated.

Primary hyperparathyroidism is due to hyperplasia or to adenomatous or carcinomatous degeneration of glandular tissue. It causes relapsing nephrolithiasis and, more seldon, nephrocalcinosis. Bone shows increased osteoclastic activity with various aspects of diffuse demineralization. In severe cases pathological fractures and sub-periosteal, sub-chondral reabsorptions appear, especially at the tendon and capsuloligamentous insertions. In even more severe disease fibrous osseous cysts and brown tumours may be found in bone.

In the central nervous system, clinical symptoms, such as mental confusion, lethargy and exceptionally coma may appear. Radiologically, bone resorption can be observed in the skull as microlacunar confluent osteolysis (salt and pepper skull). Body fractures may develop in the spine.

Secondary hyperparathyroidism is due principally to renal failure. Both hypocalcaemia and hyperphosphoraemia cause the hormone secretion increase. In this case, other pathologic features are associated with the typical manifestations of primary hyperparathyroidism.

The uraemic kidney is inable to synthetize active vitamin D, leading to rickets in the young and osteomalacia in adults. Hyperphosphoraemia causes ectopic periarticular calcifications. Furthermore, the lack of degradation of an endogenous protein (beta 2 microglobulin) by the kidney and its poor elimination by dialytic treatment, cause chronic retention and consequent systemic amyloidosis which induces intraosseous cystic lesions and severe destructive arthropathy. All these aspects, together, are known as renal osteodystrophy.

The radiological features of secondary hyperparathyroidism are the same as those observed in the primary form. In addition, all the lesions of renal osteodystrophy may be associated, further worsening the disease.

In the secondary form, mild hypocalcaemia, if present, rarely leads to the neurological manifestations of the primary disease. Frequently carpal tunnel syndrome arises due to local amyloid infarction. Chronic aluminium retention may produce neurological aspects of dementia.

Finally, the decrease of PTH hormone blood levels, as in hypoparathyroidism and the consequent hypocalcaemia may determine neurologic symptoms such as paresthaesias, and in severe disease, tetanic contractions. Radiologically, typical micronodular calcifications can be observed in the brain basal ganglia.
Pneumatizzazione ossea cranio-cervicale
Authors: Romano A. , Chibbaro S. , Fricia M. , Mancuso P. , Chiaramonte L.
Published: April 2015

Gli autori riportano il caso di un paziente giunto alla loro osservazione per una bolla di enfisema sottogaleale occipitale destra. L'esame TC del basicranio e della cerniera cranio-cervicale evidenziò un'estesa pneumatizzazione della rocca, mastoide ed occipitale di destra. Tale processo si estendeva anche al condilo ed alla massa laterale dell'atlante; fu inoltre evidenziata una bolla di enfisema all'interno del canale spinale lateralmente al dente dell'epistrofeo.

Gli autori ritengono che alla base di tale abnorme pneumatizzazione sia un'eccessiva crescita dell'epitelio di rivestimento dell'antro timpanico all'interno delle strutture del basicranio, tale pneumatizzazione potrebbe in seguito diventare evolutiva mediante un meccanismo a valvola.

Gli autori concludono sottolineando come la malformazione descritta possa essere alla base di un pneumocefalo iperteso con conseguente comparsa di sintomatologia neurologica acuta.
Functional Evaluation of the Lumbar Spine with Axial Loaded Computed Tomography (AL-CT) and Cine AL-CT
Authors: Cartolari R.
Published: April 2015

This study reports a personal experience in the functional study of the lumbar spine with original diagnostic techniques called Axial Loaded Computed Tomography (AL-CT) and Cine AL-CT, based on the use of the Axial Loader, a device that develops a variable and reproducible axial load in a supine patient during computed tomography or magnetic resonance investigation3,4.

We built a non ferromagnetic, X-ray transparent bed (the Axial Loader), with double blocking rests for shoulders and feet, that can be used during CT and MR spine studies. The inferior block is a platform that moves continuously in a longitudinal direction, with a micrometric mechanism. A dynamometer placed between the inferior platform and the patient's feet can measure the load applied.

We studied 75 patients, with a clinical and diagnostic suspicion of lumbar spine instability. The examinations were performed on a conventional CT unit (GE Sytec 3000, General Electric, Milwaukee) with a “volumetric” approach to the lumbar spine.

In conclusion, AL-CT and Cine AL-CT is currently the only diagnostic modality that can give dynamic information on the differents UFSs in all their components in one mildy invasive, easily reproducible diagnostic examination.
The Fatty Disc: An Unusual Cause of Bright Intervertebral Disc on T1-Weighted Conventional Spin-Echo MR: A Case Report
Authors: Blandino A. , Longo M. , Loria G. , Gaeta M. , Pandolfo I.
Published: April 2015

A hyperintense intervertebral disc on T1-weighted spin-echo MR image, the “bright disc”, is described in a patient with a long-standing ankylosing spondylitis.

The high signal intensity was due to the fatty infiltration of the discal tissue, as was clearly demonstrated by the comparison of MR and CT scan of the lumbar spine, probably due to progressive endochondral ossification with subsequent bone marrow metaplasia in the ossified disc.
L'aumento del segnale di colina coincide con la trasformazione maligna dei gliomi cerebrali: Studio longitidinale con imaging di spettroscopia protonica in risonanza magnetica
Authors: Tedeschi G. , Lundbom N. , Raman R. , Bonavita S. , Duyn J.H. , Alger J.R. , Di Chiro G.
Published: April 2015

We tested the hypothesis that proton magnetic resonance spectroscopic imaging (1H-MRSI) can be used as a supportive diagnostic tool to differentiate clinically stable brain tumors from those progressing as a result of either low-to-high grade malignant transformation or of post-therapeutic recurrence.

Twenty-seven patients with histologically verified cerebral gliomas were studied repeatedly with 1H-MRSI over a period of 3.5 years. At the time of each 1H-MRSI study, clinical examination, MRI, positron emission tomography (PET) with 18F-fluorodeoxyglucose (FDG), and biopsy findings (when available) were used to categorize each patient as being either «stable» or «progressive». Measures of the between-studies percent changes in the choline 1H-MRSI signal intensity, obtained without knowledge of the clinical categorization, segregated the groups with a high degree of statistical significance.

All progressive cases showed a between-studies choline signal increase of more than 45%, while all stable cases showed an elevation of less than 35%, no change, or even a decreased signal. We conclude that increased choline coincides with malignant degeneration of cerebral gliomas, and therefore, may possibly be used as a supportive indicator of malignant degeneration of these neoplasms.
Xantoastrocitoma pleomorfo dell'uncus Presentazione di un caso
Authors: Armentano A. , Fera F. , Bartone P. , Aguglia U. , Pardatscher K.
Published: April 2015

A 12-year-old boy with intractabile seizure and MR evidence of an exophitic mass of the right uncus with an enhancing nodule is reported. Histological examination revealed a pleomorphic xantoastrocytoma. On the review of the literature, the peculiar neuroradiological aspects are considered.
Studio neuroradiologico della diastematomielia: Correlazioni con l'embriopatogenesi
Authors: Pappalardo S. , Sparacia G. , Manfrè L. , Angileri T. , Brancatelli G. , Morello A. , Lagalla R.
Published: April 2015

Diastematomyelia is an uncommon defect of the neural axis and spinal column involving a sagittal cleft in the spinal cord and/or cauda equina, and phylum terminale; a spur of bone, cartilage or fibrous tissue separes two distinct spinal compartments and hemicords.

A true double cord, each with four nerve roots is traditionally defined as diplomyelia.

Associated cutaneous, skeletal or visceral anomalies are very common. Clinical onset occurs most frequently in adulthood, with low back pain, perineal hyperpatia and symptoms of motor and sensory deficit. In infantile onset cases pain is less frequent while neurologic symptoms prevail with orthopedic complications. Symptoms generally resemble tethered cord syndrome.

Several hypotheses have been advanced to explain the embryopathogenesis of diastematomyelia, and they give rise to the current accredited theory, recently proposed by Pang and Coll.

This paper resembles these hypoteses and explanes the actual accepted theory: the formation of an “ectopic or accessory neurenteric canal” abnormally joining the ectodermal and entodermal layers, bisects the notocord in its cranial development from Hensen's node; a regional splitting of the notocord takes place at this level and the maturative outcome is a split spinal cord with spinal dysraphism.

Recently (1992) Pang and Coll. perfected this theory postulating a migration of mesenchymal cells along the accessory neurenteric canal, to form an “endomesenchymal tract”. The presence of displaced mesenchyma other than ectoderm and endoderm, is able to explain the entire complex of associated anomalies in diastematomyelia. Finally, they have by-passed the traditional distinction between diastematomyelia and diplomyelia, proposing a new unified theory of “Split Cord Malformations” (SCM).
Classificazione radioprotezionistica dei lavoratori e indennità di rischio da radiazioni per il personale delle unità operative di Neuroradiologia alla luce del DL 230/95
Authors: Coppola M. , Coppola V. , Maraziti G. , Alfinito M. , Molese V.
Published: April 2015

The coming into force of the Italian law 230/95 determined a series of cultural and behavioural consequences, in particular concerning the classification of the staff and the radiation risk indennity.

These two situations are not complementary but declassing the staff intended for the Neuroradiology Unit from professions exposed (DPR 185/64) to B (DL 230/95) will have repercussion also on the specific professional indemnity.

It is necessary not to underestimate the “classification problem” that will be formulated by the qualified expert and, therefore, a thorough verification of the report of the radioprotection supervision.
Imaging e spettroscopia RM dell'idrogeno dell'encefalo in soggetti con LES ad esordio pediatrico
Authors: Mortilla M. , Ermini M. , Nistri M. , Dal Pozzo G. , Falcini F.
Published: April 2015

Nel 30–60% dei soggetti con LES ad esordio pediatrico è stato descritto un coinvolgimento del SNC. In studi precedenti sono state riscontrate alterazioni metaboliche tramite indagine con SPECT cerebrale.

Sono stati studiati con Risonanza Magnetica (Imaging e Spettroscopia 23 soggetti (18 F e 5 M; età media 15, 4 anni; range 8–27) con LES, 20 controlli di età e sesso adeguati, 5 soggetti con forma giovanile di dermatomiosite (5 F), 2 con sclerosi sistemica (1 F e 1 M) e 1 con malattia di Behçet (1 F). Altre 2 ragazze con LES erano state sottoposte all'esame RM, ma sono state escluse dallo studio per il rilievo di grossi artefatti dovuti alla presenza di apparecchio metallico ortodontico fisso.

Gli esami sono stati effettuati con apparecchio Philips ACS-NT (Best, Olanda) 1,5T. Sono state eseguite scansioni assiali spin eco T2 e FLAIR, scansioni sagittali turbo T2 (5mm di spessore) e spettroscopia dell'idrogeno di un singolo volume 70times50times20mm (TE 272ms, TR 2000ms) posizionato sulla sostanza bianca sopraventricolare.

16 pazienti affetti da LES presentavano dati anamnestici e clinici di coinvolgimento del SNC: tra questi soltanto 9 hanno mostrato alterazioni all'esame di Imaging preliminare (atrofia e/o piccole lesioni focali della sostanza bianca). Anche in 2 dei pazienti senza sintomi neuropsichiatrici il quadro neuroradiologico è risultato alterato. L'indagine spettroscopica ha evidenziato una correlazione tra l'attività della malattia e la diminuzione dell'N-acetilaspartato espresso come rapporto NAA/Cr.

11 pazienti sono stati esaminati durante la presenza di sintomi neuropsichiatrici: tra questi 5 pazienti sottoposti a un prolungato periodo di trattamento con corticosteroidi per un coinvolgimento sistemico della malattia più marcato hanno mostrato il più basso valore del rapporto NAA/Cr. 2 tra essi hanno mostrato il quadro neuroradiologico nella norma.

Dunque la Risonanza Magnetica per immagini e la Spettroscopia possono essere indagini non invasive da utilizzare in soggetti con LES pediatrico sia per rilevare un coinvolgimento precoce dell'encefalo sia per monitorizzare la gravità della malattia.
Ottimizzazione di un protocollo RM per lo studio dell'encefalo neonatale
Authors: Triulzi F. , Baldoli C. , Bianchini E. , Parazzini C.
Published: April 2015

A fast, high quality MR study protocol for the neonatal brain is proposed. It allows to achieve in little more than 4 minutes and an half a complete set of strong T2 and T1-weighted high quality images of the entire neonatal brain. To optimize the signal to noise ratio a circular polarized coil with a small diameter (20 cm) was used. For the T2-weighted sequence a fast spin-echo sequence with and echo train of 15, TR 5200 and TE 132 was performed, whereas a fast true inversion recovery with an echo train of 11 was utilized for the T1-weighted sequence. Field of view was mainly 130 mm for both sequences with a pixel size of 0,81times0,51 and 0,74times0,51 respectively. Up to now 30 patients were studied with this technique. The short total acquisition time allows more reliable studies in non sedated patients; the use of true inversion recovery sequence allows better contrast resolution between gray matter and unmyelinated white matter and between unmyelinated and myelinated white matter.
Tecniche di angio-RM: Stato dell'arte
Authors: Cellerini M. , Konze A. , Sottili P. , Pellicanò G. , Dal Pozzo G.
Published: April 2015

MRI is very sensitive to flow effects and they may be exploited to develop non-invasive techniques for imaging of the vascular anatomy. These techniques are referred to as Magnetic Resonance Angiography (MRA). MRA techniques can be classified in two major categories: time-of-flight (TOF) and phase contrast (PC). Both techniques rely on different physical effects; inflow-enhancement and flow-induced phase shift respectively. In both techniques definitive angiographic images are obtained by means of post-processing of data with a Maximum Intensity Projection (MIP) algorithm.

TOF MRA can be classified in three major categories: 2D-sequential, 3D-volumetric and multi-slab-3D (MOTSA). To improve vessel-background contrast in TOF MRA, new techniques, such as ramped radiofrequency (rf), pulses across the slab to partially compensate for the progressive saturation of spins (TONE) and magnetization transfer contrast (MTC) have been introduced.

In PC MRA complex subtraction of two data sets with a different amount of flow sensitivity produces an image with signal intensities depending on flow velocity. Quantitative information about flow velocity and flux can also be obtained in PC MRA. More recently the use of contrast agents with ultrafast imaging (CE-MRA) has shown significant improvements in the delineation of the vessel lumen.
RM perfusionale nell'ictus ischemico
Authors: Gallucci M.
Published: April 2015

The main application of perfusional techniques based on MR concerns the evaluation of stroke. Our experience, based on 25 cases (15 acute) confirms the literature data, allowing to affirm its simplicity (2 minutes of acquisition, obtainable also with low field equipments). In perspective it is possible to foresee an increasing employment that, in case of stroke, could: 1. facilitate the differential diagnosis; 2. allow the early recognition of the ischemic area (in the first minutes after the occlusion); 3. facilitate the prognostic judgment; 4. help in differentiating the ischemic core from penumbra; 5. replace SPET in the evaluation of the so-called therapeutic window; 6. allow the correct selection of pts susceptible of thrombolitic therapy, excluding those with spontaneous recanalization; 7. appraise the effectiveness of thrombolitic therapy in follow-up evaluations.

To our opinion, however, much more interesting seems the possible application in prevention, and, more particularily, in: 1. evaluation of critical zones in subjects with stenosis of big vessels; 2. study of the efficiency of collateral supply; 3. evaluation of the vasodilatory reserve (i.e.: pharmacological tests); 4. presurgical planning (perfusional MR together with MRA will replace cateter angiography?)
Il ruolo dell'Angio TC spirale nella valutazione diagnostica della biforcazione carotidea
Authors: Floris R. , Bozzao A. , Mulas M. , Apruzzese A. , Salvatore C. , Simonetti G.
Published: April 2015

Il ruolo della Angio TC spirale nella valutazione diagnostica della biforcazione carotidea per la selezione di pazienti da sottoporre ad endo-arterectomia è ancora da definire.

Lo scopo del nostro studio è quello di valutare l'accuratezza dell'Angio-TC spirale rispetto all'Angiografia carotidea. Abbiamo sottoposto ad Angio-TC spirale dei vasi epiaortici 46 pazienti (92 biforcazioni carotidee) entro 48 ore dall'esame angiografico, utilizzando un apparecchio TC spirale con tubo ad elevate prestazioni (Philips Tomoscan SR 7000). E' stato utilizzato un bolo di contrasto di circa 120 cc con 3 mm di spessore e 3 mm di avanzamento (Pitch=l) ottenendo immagini ricostruite sul piano assiale di 1 mm successivamente elaborate con algoritmo MIP.

L'Angiografia carotidea è stata eseguita in almeno due proiezioni per ciascuna biforcazione carotidea ed il grado della stenosi valutato secondo i criteri NASCET.

La concordanza tra Angio-TC spirale ed Angiografia carotidea è stata di circa il 90% con minore correlazione per le stenosi di grado lieve e moderato. L'Angio-TC è risultata superiore nella rilevazione di placche calcifiche.
Analisi della tecnica Angio-TC-3D nello studio delle steno-occlusioni carotidee
Authors: Cimino C. , Chiapparini L. , Bruzzone M.G. , Ciceri E. , Carriero M.R. , Lombardi B.
Published: April 2015

L'angio-TC e le tecniche di ricostruzione tridimensionale su work-station sono strumenti che permettono di studiare la patologia steno-occlusiva dei vasi al collo, ottenendo informazioni sulla morfologia, sull'estensione delle placche ateromasiche e sull'entità delle stenosi. Mentre appare sempre più emergente il ruolo dell'angio-TC come esame di screening per tale patologia, in letteratura non vi è unanimità di giudizio sulla possibilità che questa tecnica, da sola o in associazione con altre non invasive, possa sostituire l'angiografia in previsione di un intervento chirurgico.

Scopo di questo lavoro è analizzare la sensibilità, la specificità e l'accuratezza diagnostica di questa tecnica, comprensiva delle successive elaborazioni con programmi di ricostruzione tridimensionale, rispetto a metodiche più tradizionali quali l'angio-RM, l'eco-color-doppler, l'angiografia digitale. Dato il prevedibile aumento di richiesta di esecuzione di questo esame saranno inoltre presi in considerazione altri parametri. In primo luogo sarà considerato il rapporto tra il tempo complessivo dedicato sia all'esecuzione dell'esame (impostazione dei protocolli di acquisizione, scelta della regione di interesse, scelta dei corretti parametri di somministrazione del bolo) sia l'elaborazione delle immagini (scelta del programma di ricostruzione, del target, eventuale segmentazione) e la qualità e l'affidabilità del risultato rispetto ad altre tecniche. Verrà infine considerato il costo biologico dell'esame in termini di dose somministrata al paziente.

Data la recente installazione presso il nostro servizio di un'apparecchiatura TC spirale e di work-station per elaborazioni 3D, MIP, MPR, etc., ci proponiamo di utilizzare per questo studio un campione di 20 pazienti con TIA o minor stroke. Tutti questi pazienti saranno sottoposti ad eco-color-doppler, angio-TC, angio-RM e angiografia digitale.
Angio-TC degli aneurismi: Certezze e controversie
Authors: Tamarozzi R. , Ceruti S. , Calzolari F. , Saletti A.
Published: April 2015

The role of CT-Angiography (CTA) in the diagnosis of cerebral aneurysms has not been definitively established. It depends mainly either on the low spreading of helical-CTs and on the quality of the reconstructive techniques in different equipment. Aim of this paper is to discuss certainties and controversies in the use of CTA in the diagnosis of cerebral aneurysms.

CTA can be performed in conjunction with conventional CT with minimal additional scanning time, mainly important in emergency. CTA well-defines shape, size and orientation of the aneurysm, if the scans are free of artefacts and if it is possible to well subtract bones and veins. Technology improvements are awaited in the near future to shorten the time of acquisition, increasing the volume acquired and reducing artefacts. The use of multi-array systems of acquisition, more powerful algorithms to reduce artifacts and software able to define correctly the time of injection of the contrast medium could help to reach the goal of showing all the brain arteries free of artefacts and superimposed veins. At present CTA can substitute angiography in emergency when there is no time to perform angiography and when there is CTA evidence of an aneurysm associated with local haematoma.
Radioterapia stereotassica versus radioterapia convenzionale nel trattamento dei tumori cerebrali
Authors: Ruggiero R.
Published: April 2015

Steiner nel 1968 iniziò ad applicare la radiochirurgia stereotassica nel trattamento delle malformazioni artero-venose mediante l'erogazione di una singola alta dose di radiazioni concentrata sul bersaglio.

Le lesioni suscettibili di tale trattamento non potevano avere diametro superiore a mm. 18.

Il progresso tecnologico che si è avuto nell'ultimo decennio con la possibilità di predisposizione dell'acceleratore lineare alla metodica stereotassica e l'utilizzazione di caschi non invasivi, ha reso possibile l'inserimento di questo tipo di radioterapia nel protocollo terapeutico di lesioni encefaliche neoplastiche di differente neura.

La radioresistenza della maggioranza di questi processi espansivi limita l'efficacia biologica della radioterapia convenzionale a dosi frazionate, in quanto con questa metodica non è possibile erogare dosi superiori a 60 Gy senza produrre danni notevoli al tessuto cerebrale sano.

Viceversa, l'utilizzo di un sistema stereotassico non invasivo e l'impiego di più isocentri consente attualmente l'erogazione di più dosi singole meno elevate, permettendo così l'aggressione di lesioni piuttosto estese e geometricamente complesse.

In questo lavoro viene presentata la nostra esperienza nell'applicazione della radioterapia stereotassica, iniziata nel giugno 1991, e vengono poste alcune considerazioni sui vantaggi e sui limiti attuali di questa metodica.
Epilessia gelastica ed amartomi del tuber cinereum
Authors: Caranci F. , Castellano E. , Esposito G. , Zona G. , Cirillo S. , Striano S. , Elefante R.
Published: April 2015

A detailed study of three patients with gelastic seizures and a review of the literature are presented. Hamartoma of the tuber cinereum was diagnosed in two cases, subependymoma of the floor of the third ventricle in the third patient. The mechanism of ictal laughter, clinical associations and prognosis for seizure control are discussed. The resolution of MR imaging provides a basis to correlate some of the clinical manifestations with the anatomical disposition of the lesions within the hypothalamus.
Pseudotumor orbitario: Semeiotica TC-RM e diagnosi differenziale
Authors: Roncallo F. , Turtulici I. , Bandini F. , Mazzella A. , Giberti L. , Calautti C. , Bartolini A.
Published: April 2015

Lo Pseudotumor Orbitario (PO) viene definito come un processo flogistico aspecifico ed idiopatico per il quale non è possibile identificare una causa locale o riscontrare una patologia sistemica. Si può manifestare clinicamente in diversi modi a seconda delle strutture anatomiche orbitarie coinvolte e la sintomatologia è comunque del tutto aspecifica. Scopo del lavoro è identificare le diverse varianti di PO, con particolare riguardo alla diagnosi differenziale con altra patologia, specie quella neoplastica.

Sono stati valutati retrospettivamente 50 esami TC ed RM mirati sulle regioni orbitarie, in pazienti affetti da patologia non traumatica, responsabile della sintomatologia. Successivamente abbiamo stratificato gli esami a seconda della struttura anatomica prevalentemente coinvolta: 1. Loggia lacrimale (8 casi); 2. Muscolatura estrinseca oculare (14 casi); 3. Complesso nervo ottico-involucri meningei del nervo (12 casi); 4. Vena oftalmica superiore (7 casi); 5. Apice orbitario (5 casi); 6. Tessuti orbitari retrobulbari (3 casi).

Ognuna di queste diverse strutture può essere selettivamente interessata dallo PO. Per quanto concerne la diagnosi differenziale sono stati riscontrati: 1. Loggia lacrimale: PO (4), Linfoma (2), Flogosi settica (2); 2. Muscolatura estrinseca oculare: PO (6), Oftalmopatia Base-dovviana (5), Metastasi (2); 3. Complesso nervo ottico-involucff meningei del nervo: PO (4), Malattie autoimmuni (4), Meningioma (2), Linfoma (1), Glioma (1); 4. Vena of ialmica superiore: PO (1), Fistola carotido-cavernosa (3), Varice orbitaria (3); S. Apice orbitario: PO (2), Metastasi (2), Meningioma (1); 6. Tessuti orbitari retrobulbari: PO (1), Linfoma (1), cellulite settica (1).

Lo PO rappresenta una frequente causa di lesione organica orbitaria dell'adulto. La diagnosi differenziale di natura con altra patologia non sempre è facile su pura base morfologia ed anche la biopsia può fornire dati incerti, specie per quanto riguarda la differenziazione dal linfoma. Emerge quindi l'utilità di restringere al massimo il campo delle ipotesi diagnostiche, unito al criterio ex-adiuvantibus della risposta allo steroide, limitando l'accertamento istologico ai casi non rispondenti.
Stadiazione e controllo dei carcinomi del rinofaringe
Authors: Roncallo F. , Turtulici I. , Giberti L. , Bartolini A.
Published: April 2015

Prognosis and treatment of Head and Neck tumours (HNT) are correctly planned if the analysis of their grading is accompanied by a careful neuroradiologic study of their spatial extension, lymph node involvement, before and after radiotherapy (RT).

CT and MRI are suitable devices for this purpose, since they can help in studying an anatomical region which is difficult to visualize with endoscopy. Aim of the present study is to evaluate the parameters to be considered staging of HNT also after therapy.

25 patients, aged between 26 and 73 years, underwent CT and MRI before and after radiotherapy, alone or associated with chemotherapy. Standard TNM classification was used. T evaluation considers spatial extension to mucosal, descending, ascending, lateral, posterior, perineural, perivascular spaces of the primary lesion; N considers side, borders and location of the involved lymph nodes; after treatment, these two parameters evaluate size reduction and iatrogenic modifications in the tumour mass and lymph nodes.
Angio-RM post-trattamento delle malformazioni vascolari spinali
Authors: Ferrito G. , Mascalchi M. , Scazzeri F. , Prosetti D. , Petruzzi P. , Tessa C. , Mangiaelco S. , Cosottini M. , Quilici N.
Published: April 2015

Twenty-five patients with spinal vascular malformations demonstrated by spinal arteriography (21 dural arteriovenous fistulas, 2 perimedullary arteriovenous fistulas and 2 intramedullary arteriovenous malformations) underwent MR imaging and contrast enhanced phase-contrast MR angiography before and after endovascular (n?18) or surgical (n=7) treatment.

In 3 patients with dural arteriovenous fistula treated with glue embolization, early post-treatment MR angiography showed persistence of flow in the perimedullary vessels. The patency of the fistula was confirmed by spinal arteriography or surgery in all three patients. In two other patients with dural arteriovenous fistulas treated with glue injection, delayed MR angiography showed flow in perimedullary vessels which was not observable in early post-treatment MR angiography controls. Reopening (“recurrence”) of the fistula was confirmed by arteriography in one patient. In the remaining 16 patients with dural arteriovenous fistula, post-treatment MR angiography showed disappearance of flow in the perimedullary vessels consistent with obliteration of the fistula. This finding was associated with persistent intramedullary signal changes and contrast enhancement in 13 patients and perimedullary contrast enhancing vessels in 6 patients. Arteriography in one of the latter patients showed exclusion of the fistula confirming the result of the posttreatment MR angiography study.

In the 4 patients with high flow spinal vascular malformations, all treated with endovascular approach, early post-treatment MR angiography showed reduction or disappearance of flow in the abnormal vessels. This remained unchanged in two patients, where as increased flow in the same vessels was demonstrated by further follow-up MR angiography studies in two patients. Phase contrast MR angiography is a useful complement to MR imaging in the post-treatment evaluation of spinal vascular malformations. An early post-treatment MR-angiography control is recommended as it enables prompt identification of treatment failures and may constitute a reference term for lesion monitoring over time.
Degenerazione ipertrofica delle olive inferiori Segnalazione di un caso
Authors: Lanza P.L. , Auteri W. , Armentano G.A. , De Vuono G. , Santoro G.
Published: April 2015

Olivary hypertrophic Degeneration (OHD) is usually due to hemorrhagic lesions in the “Guillain Mollaret” triangle: trangular morphologic and functional relationship between the red nucleus and inferior olivary nucleus on one side and the controlateral dentate nucleus.

The hemorrhage involves the pons-midbrain tegmentum on the same side of the olive or the controlateral superior cerebellar peduncle and/or dentate nucleus.

It is regarded as transsynaptic degeneration and has typical MR features: morphologic changes and increased signal intensity on DP-T2 weighted images, with a carachteristic chronologic evolution after acute injury.

We present a case report.
Analisi gestionale sull'indagine radiografica nei traumi cranici
Authors: Coppola V. , Brunese L. , Ranieri P. , Alfinito M. , Coppola M. , Maraziti G. , Noviello D.
Published: April 2015

23415 x-ray examinations of the skull performed in an emergency department were examined retrospectively.

The results show that it is wrong and dangerous, for medical-legal reasons, to perform x-ray examinations of the skull systematically in institutions where CT is available, as:

– the uselessness of the examination, also for legal purposes, has been demonstrated; – its cost is twice the CT examination, on average; – the radiologist's and the technician's demotivation compromises the diagnostic effectiveness in every case; – the unmotivated use of CT and hospitalization becomes more frequent; – the execution time is wasted and not useable otherwise; – the deleterious sectorialization between abdominal and cerebral radiologists hampers the global and overall evaluation of the traumatised patient; – radioprotection reasons press for a more cautious use of radiation.
Magnetic Resonance Angiography for Evaluation of Intracranial Aneurysms Treated with Guglielmi Detachable Coils
Authors: Cotroneo E. , Dazzi M. , Gigli R. , Guidetti G. , Cantore G.P. , Chiappetta F.
Published: April 2015

Thirteen cases of cerebral aneurysms submitted to endovascular treatment using Guglielmi detachable coils (GDC) are described. Control MRI-angiography 3D TOF was performed three and six months later.

In order to spare patients the discomfort and risks related to repeated trauma and iodate contrast injection, we examined the possibility of an alternative non-invasive diagnostic method. For this purpose, the digital subtraction angiograms performed three and six months after embolisation were compared with the MR-angiograms obtained in the same period, all using the same tomograph at middle field intensity (0.5T). We discuss the outcome of this comparison and the limits of the MR-angiography method in the follow-up of aneurysms submitted to endovascular treatment.
Orbital Pseudotumour: Clinical and Radiological Assessment
Authors: Roncallo F. , Bandini F. , Mazzella L. , Giberti L. , Turtulici I. , Bartolini A
Published: April 2015

Orbital Pseudotumour (OP) is an antiquated term that denotes an idiopathic and nonspecific space-occuping inflammation of any of the orbital structures. The clinical presentation can be acute, subacute or chronic and depends on the structures involved. Aim of the study is to evaluate the different anatomic variants of OP, with emphasis on the differential diagnosis with other pathologies, especially malignancies.

We report a retrospective comparison of the clinical, CT and MR findings of 50 patients with non-traumatic orbital pathology, diagnosed between 1993 and 1996. We stratified the radiologic examinations on the basis of the main anatomic structure involved:

Lacrimal gland (8 cases); Extrinsic ocular muscle(s) (14 cases); Optic nerve-optic nerve sheaths complex (12 cases); Superior ophthalmic vein (7 cases); Orbital apex (5 cases); Retrobulbar soft tissues (3 cases).

We found no specific clinical signs or pathognomonic CT or MR findings to establish a certain diagnosis, although contrast enhancement was present in 100% of the cases and could thus be considered a distinguishing feature. We also found a good correlation between the location and the extent of the disease as identified on CT and MR scans with the clinical presentation.

With regard to differential diagnosis we found:

Lacrimal gland: PO (4), Lymphoma (2), Septic dacryoadenitis (2); Extrinsic ocular muscle(s): PO (7), Thyroid ophthalmopathy (5), Metastasis (2); Optic nerve-optic nerve sheaths complex: PO (4), Autoimmune diseases (4), meningioma (2), Lymphoma (1), Glioma (1); Superior ophthalmic vein: PO (1), Carotid-cavernous fistula (3), orbital varyx (3); Orbital Apex: PO (2), Metastasis (2), Meningioma (1); Retrobulbar soft tissues: PO (1), Lymphoma (1), Septic cellulitis (1).

OP represents a frequent cause of orbital pathology in the adult. The differential diagnosis with other entities is not always simply on the basis of morphologic pattern and the biopsy may also be inconclusive, especially in distinguishing between OP and lymphoma.

All but one patients improved clinically following administration of corticosteroids and the abnormalities on the CT and MR scans disappeared or became less prominent within 45 days after starting the steroid treatment. The radiologic recognition of this particular disease is important since the response to steroid therapy is almost always dramatic and the prognosis for complete recovery is relatively good. Biopsy is reserved only to steroid non-responder patients.
Sindrome da ipotensione liquorale secondaria a rachicentesi in un paziente con AIDS linfoma non Hodgkin
Authors: Crispino M. , Prandini F. , Gregis G.P. , Oladeji O.A. , Nasta P. , Pavia M. , Bonetti M. , Gasparotti R.
Published: April 2015

Viene descritto il caso di un paziente affetto da AIDS e Linfoma non Hodgkin con sindrome da ipotensione liquorale secondaria a ripetute punture lombari.

La TC e la RM mostravano una duplice raccolta sottodurale a contenuto liquorale, con impregnazione della pachimeninge, associata ad effetto compressivo sull'encefalo e dislocazione verso il basso del tronco encefalico.

Il quadro clinico si risolveva spontaneamente in circa due settimane, così come confermato dai reperti neuroradiologici.
Compressive Vertebral Angioma
Authors: Izzo R. , Muto M. , Fucci G. , Cantatore G. , Simpatico S. , Avella F.
Published: April 2015

We describe a case of compressive vertebral angioma characterized by unexpected onset and the rapid development of signs of spinal medulla compression not preceded by painful symptomatology.

Haemangioma is the most common benign tumour in the spine. In the vast majority of cases it is a small, clearly located and circumscribed vascular dysplasia which is stable over time, asymptomatic and is detected by chance via radiological control.

In rare cases vertebral angioma with tumoral behaviour can have an extensive effect on the vertebral body and arch and invade the spinal canal causing myeloradicular compression.

This type of angioma, defined as compressive, is a developing lesion which necessitates full radiological assessment and decompression therapy, to be carried out in certain cases and in our case, as part of an emergency regimen.

Between the two extreme forms of angioma, compressive and asymptomatic, there are the painful or symptomatic forms classified as both compressive in the transitional phase and as lesions of intermediate aggressiveness which are not destined to develop further.
18FDG-SPECT Imaging of Brain Tumours
Authors: Reiche W. , Schaefer A. , Schmidt S. , Moringlane J. R. , Feiden W , Kirsch C. M. , Piepgras U.
Published: April 2015

The purpose of this prospective study was to examine, if it is possible in principal to obtain suitable information to grade brain tumours and detect recurrences in follow up with 18Fluoro-Deoxyglucose (18FDG) and Single Photon Emission Computed Tomography (SPECT) using ultra high energy collimators. Fifty two brain SPECT investigations were carried out in 41 patients. Forty patients had primary brain tumours and one an anaplastic meningioma. SPECT acquisition was started 30 min after application of 400 MBq 18FDG using special high energy 511 KeV collimators.

After attenuation correction (coef.= 0.07 cm−1/) brain tumour FDG uptake was quantified as ratio to contralateral brain cortex (RUV: relative uptake value). SPECT data were compared with histopathological findings and CT/MR images. In grade 4 gliomas (glioblastomas), 18FDG uptake depended on the ratio viable tumour tissue, taking up contrast media in CT/MRI, to cystic tumour areas. Two cases showed increased uptake (RUV = 1.33 and 1.05) compared to the contralateral cortex and four with central necrosis a decreased uptake (RUV = 0.79 ± 0.14). Grade 2 gliomas (five cases) showed a decreased 18FDG uptake (RUV = 0.68 ± 0.02) compared with contralateral brain cortex.

In grade 3 astrocytomas (two cases), 18FDG uptake was significantly lower than cortex uptake, but slightly increased when compared with white matter uptake (RUV = 0.79 and 0.82). In follow-up, eight patients with a grade 4 glioma recurrence and one patient with a medulloblastoma recurrence showed an increased 18FDG uptake (RUV = 1.2 ±0.09 and 1.2). In one grade 4 glioma recurrence, SPECT results were false negative showing decreased FDG-uptake due to the presence of necrotic areas induced by radiotherapy. Grade 2 glioma recurrences (eight cases) showed low 18FDG uptake values (RUV = 0.73 ± 0.11). Radionecrosis also showed a decreased 18FDG uptake (RUV = 0.64 ± 0.09) compared with unaffected cortex.

These results demonstrate that grading and follow-up tests of brain tumours are possible with 18FDG-SPECT, although SPECT with high energy collimators provides a relatively poor spatial resolution which requires further technical improvements.
Colloid Cyst
Authors: Duca S. , Salzedo E.
Published: April 2015

Colloid cysts are rare benign intracranial tumors most commonly found in the third ventricle, but also in the subarachnoid spaces and within the brain parenchyma. Many names have been proposed depending on their location, such as neuroependymal cyst, ependymal cyst, glioependymal cyst, choroid plexus cyst and epithelial cyst.

From the neuroradiological point of view two forms have been described: a “solid” form with a compact round mass that is iso-hyperdense in CT and slightly hyperintense in T1W and highly hypointense in T2W MR images, and a “cystic-solid” form, characterised by a peripheral fluid collection surrounding a solid central core.

This report describes the modifications of a solid form in a cystic-solid cyst, not previously described in the literature, and its evolution after neurosurgical drainage of the fluid collection. Some pathogenetic hypotheses on intracystic fluid production are discussed and displacement of the central solid core inside the cyst is shown.
Optic Nerve and Chiasma Compression by a Dolichoectatic Internal Carotid Artery
Authors: Blandino A. , Longo M. , Salpietro F.M. , Alafaci C. , Narbone C. , Bramanti P. , Pandolfo I.
Published: April 2015

We describe an unusual type of neurovascular conflict between an elongated internal carotid artery and the optic nerve-chiasma complex.

The fundamental role of conventional MR and MR angiography in the demonstration of the neurovascular conflict is illustrated.
Cystic Dilatation of the Cistern of the Velum Interpositum
Authors: Muras I. , Rispo A. , Bernini F.P.
Published: April 2015

Three peculiar cases with cystic dilatation of the “cavum Veli interpositi” have been observed. This structure contains a narrow subarachnoid space; dilatation of this cistern was rarely found in conditions interfering with normal drainage of the subarachnoidal pathways. We describe the clinical and MR findings due to this very uncommon condition; correlative anatomy and differential diagnosis are also discussed.