bluuebunny/crossref_metadata_2025 huggingface dataset:
Iter diagnostico nella patologia dei tronchi epiaortici: Il punto di vista del chirurgo vascolare
Authors: Mozzon L. , Fregonese V.
Published: April 2015

The Authors report their 15-years surgical experience discussing the most suitable imaging methods for the diagnosis and treatment of extracranical artery disease. Cost-effectiveness with the use of Duplex scan, conventional or magnetic resonance angiography, is especially underlined and stressed.

The preoperative assessment of candidates for carotid endarterectomy should not yet exclude conventional X-ray angiography: the technological development and improvement of magnetic resonance will probably lead to a change.
L'Angio-TC del circolo intracranico nella patologia cerebro-vascolare
Authors: Cartolari R.
Published: April 2015

The assessment of the etiology of cerebro-vascular diseases (atherosclerotic plaques, vascular stenosis) with DSA is difficult and invasive, while, on the contrary, CT and MRI allow easy visualization of the acute and chronic sequaeles of cerebro-vascular deseases.

In the last years, techniques alternative to DSA, such as MR-Angiography (MRA) have been developed; the recent volumetric approach in CT (Spiral-CT) provided with new possibilities for CT-Angiography (CTA).

The conceptual similarity (i.e. the volumetric approach) with the MR 3D techniques, and the short time for data acquisition allowed to transfer to CTA the whole post-processing modalities of MRA, as 3D MIP and 3D SSD. In the near future the further development of virtual endoscopy will make possible an affordable direct intravascular investigation of vessels lumen.
Misure di flusso cerebrale, tempo di transito, volume vascolare e permebilità di barriera nelle lesioni ischemiche con immagini funzionali derivate dall'angio-TC
Authors: Bartolini A. , Gasparetto B. , Roncallo F. , Sullo L. , Giberti L.
Published: April 2015

Transit time, vascular volume, blood brain barrier permeability and rCBF images, obtained by computerized analysis of Angio-CT, were applied to the study of cerebral ischemic patients. Our results show a considerable increase in information with respect to conventional contrast examination.
Trombosi venose cerebrali: Quadri clinico-neurologici
Authors: Bergui M. , Daniele D. , Stura G. , Bradač G.B.
Published: April 2015

La trombosi di una parte del sistema cerebrale viene riconosciuta sempre più frequentemente come causa di patologia neurologica. Il quadro d'esordio può essere subdolo e mimare, sia dal punto di vista clinico che neuroradiologico, diverse patologie (tumore, “pseudotumor”, encefalite, emorragia…); inoltre la patologia può rapidamente evolvere sia dal punto di vista clinico che dell'imaging. Il trattamento anticoagulante precoce permette un'evoluzione favorevole nella maggior parte dei casi: la diagnosi precoce diventa perciò indispensabile.

Abbiamo rivalutato 20 casi di trombosi venosa cerebrale diagnostica negli ultimi 3 anni, verificandone in particolare il ritardo diagnostico. Questo è stato in media di 4 giorni dalla prima visita neurologica o esame CT-RM; la diagnosi all'ingresso è stata di tumore, emorragia o encefalite. Sulla base del quadro clinico-neuroradiologico abbiamo identificato alcune modalità tipiche di esordio e di evoluzione della malattia: il valore diagnostico delle diverse tecniche neuroradiologiche, le difficoltà e gli errori diagnostici sono, nella nostra esperienza, fortemente condizionate dalle modalità di presentazione della patologia e dalla sua evoluzione.
Studio neuroradiologico di traumatizzati cranici con Angio-TC
Authors: Bartolini A. , Gasparetto B. , Roncallo F. , Sullo L. , Giberti L.
Published: April 2015

Regional circulation time and vascular volume were assessed in patients with cranial trauma. It was shown that changes in circulation time distinguished fairly well between patients with good prognosis (normal values) and patients with severe prognosis (changes in circulation time).
Studio Angio-RM degli aneurismi intracranici embolizzati con GDC
Authors: Cotroneo R. , Dazi M. , Gigli R. , Guidetti C. , Pingi A. , Cantore G. , Chiappetta F.
Published: April 2015

Gli autori presentano 18 casi di pazienti portatori di aneurismi cerebrali sottoposti ad embolizzazione mediante uso di spirali a distacco elettrolitico (GDC), controllati a distanza di tre e sei mesi con Angio-RM 3D TOF. Come è noto il protocollo internazionale prevede controlli angiografici a distanza di una settimana, tre mesi, sei mesi, un anno, per gli aneurismi spiralizzati con GDC. Il fine è di controllare una eventuale riabilitazione dell'aneurisma o un aumento delle dimensioni del colletto qualora questi non fosse stato totalmente obliterato.

Gli autori hanno suddiviso gli aneurismi in base alle dimensioni della sacca (<1 cm, 1–2.5 cm, >2.5 cm) e in base alle dimensioni del colletto (<4 mm o >4 mm). Inoltre gli aneurismi sono stati suddivisi, dopo il trattamento, in totalmente embolizzati, parzialmente embolizzati, ed embolizzati con residuo di colletto.

Al fine di evitare ai pazienti ripetuti esami angiografici con i rischi connessi alla somministrazione di m.d.c. iodato ed a ripetuti traumatismi nelle sedi di puntura, gli AA. hanno ipotizzato di verificare possibilità alternative di immagine. La presenza delle spirali di platino rende, per i noti artefatti, di difficile interpretazione l'Angio-TC con ricostruzione tridimensionale.

L'Angio-RM presenta limiti per artefatti dovuti a caduta di segnale proprio in prossimità del colletto dell'aneurisma per turbolenze di flusso. Tale turbolenza è un aspetto fisico che si presenta quanto la sacca aneurismatica è pervia; una volta obliterata il flusso dovrebbe risultare più regolare. Per confermare tale ipotesi, sono state confrontate le Angiografie digitali eseguite a tre e sei mesi dalla spiralizzazione con le Angio-RM eseguite nello stesso periodo tutte con il medesimo tomografo a RM di media intensità di campo (0,5T).

Gli autori illustrano i risultati, i limiti e discutono le indicazioni di un protocollo di Angio-RM per alcuni aneurismi sottoposti a embolizzazione.
Esperienza di embolizzazione di aneurismi “large” del circolo carotideo
Authors: Sirabella G. , Saponiero R. , Napoli A.N. , Simonetti L. , Briganti F. , Posteraro L. , Granieri U.
Published: April 2015

Gli autori propongono una casistica di embolizzazione di 5 aneurismi “large” del circolo carotideo. Vengono analizzati:

il proprio protocollo di preparazione del paziente; problemi tecnici di approccio all'aneurisma; pregi e difetti del materiale usato (spirale MTS e GDC); problemi collegati alla taglia dell'aneurisma, con particolare riguardo alle difficoltà di stabilire quando l'embolizzazione può essere considerata soddisfacente.
Valutazione emodinamica delle malformazioni vascolari cerebrali con Angio-TC
Authors: Bartolini A. , Gasparetto B. , Roncallo F. , Sullo L. , Giberti L.
Published: April 2015

Transit time, vascular volume, blood brain barrier permeability and rCBF images, obtained by computerized analysis of Angio-CT, were applied to the study of cerebral vascular malformations. Useful information with respect to the haemodynamic conditions of the lesions as well as the surrounding brain tissue was obtained.
Il ruolo della tomografia RM e dell'Angio-RM nello studio degli aneurismi cerebrali
Authors: Fera F. , Armentano A. , Bartone P. , Ginolfi G. , Ceccotti C. , Pardatscher K.
Published: April 2015

To evaluate the reliability of magnetic resonance angiography for detecting intracranial aneurysms a prospective study was performed in 21 consecutive patients affected by SAH and in 13 patients in whom aneurysms were suspected on standard SE RM. In the SAH cohort 8 of 21 clearly showed an aneurysm, 3 of 21 were doubtfull. In the 13 patients without SAH, aneurysms were confirmed in 12. Due to flow artefacts in the small aneurysms a deceptive pseudoloop pattern was often observed.
L'angiografia digitale nello studio dei tumori endocranici
Authors: Fabris G. , Aprile I. , Biasizzo E. , De Colle M.C. , Lavaroni A. , Tommasini G.
Published: April 2015

The development of Computed Tomography and Magnetic Resonance has reduced the diagnostic role of Digital Subtraction Angiography (DSA) in the neuroradiological evaluation of intracranial tumors. DSA is currently an important pre-surgical examination, able to offer important information regarding the type and the entity of neoplastic vascularization.

Moreover the development of endo-vascular interventional practices (pre-surgical embolization of meningiomas and endo-arterious chemotherapy of gliomas) has widened the applications of angiography.
Studio Angio-RM dei tumori del basicranio
Authors: Duca S. , Crasto S. , Salzedo E. , Bertone P. , Petricig P.
Published: April 2015

In a population of 59 patients with skull base tumors the authors made 75 MR brain and angiographic examinations to assess the efficacy of MR Angiography in the evaluation of vascular involvement of these tumors. The authors conclude that RMA gives a good map of the involvement of the great arterial and venous vessels from skull base tumors, but its low spatial resolution is not competitive with traditional angiographic techniques, in particular in the evaluation of the small arterial vessels and slow flow venous channels. MRA is useful in the follow-up of these tumors, particularly after radio-chemotherapy and after radiosurgery.
Aneurismi giganti: Trattamento combinato neurochirurgo-neuroradiologo
Authors: Guidetti G. , Dazzi M. , Santoro A. , Piattella M.C. , Cantore G.P.
Published: April 2015

Gli autori presentano due casi di aneurismi giganti intracranici esclusi dal circolo mediante trattamento combinato neurochirurgico-endovascolare.

Entrambi gli aneurismi sono stati riempiti con spirali di Guglielmi, la carotide sacrificata, il circolo intracranico preservato mediante by-pass con vena safena tra carotide e cerebrale media.

I due casi riguardano un aneurisma intracavernoso sinistro ed un aneurisma di biforcazione di carotide sinistra. è sempre stato eseguito balloon occlusion test. In un caso è residuato lieve deficit alla mano destra in regressione.

Caso 1 P. M. aa. 45 femmina. La paziente in seguito a disturbi del visus eseguiva risonanza magnetica che evidenziava la presenza di un aneurisma intracavernoso sinistro. La diagnosi veniva confermata angiografiamente; al ballon occlusion test, eseguito in carotide interna, oltre ad un modesto impaccio della parola, si osservava un parziale riempimento dell'aneurisma attraverso l'oftalmica. Veniva allora eseguito un by-pass con la safena e subito dopo la paziente veniva riportata in sala agiografica dove si riempiva l'aneurisma e la porzione sottostante di carotide con spirali GDC. L'angiografia di controllo mostrava la perfetta permeabilità del by-pass.

Caso 2 T.I. aa. 42 femmina. La paziente, portatrice di aneurisma di biforcazione di carotide sinistra, in altra sede veniva sottoposta a craniectomia e veniva protetto il fondo dell'aneurisma con colla. Giunta alla nostra osservazione, veniva embolizzata con spirali GDC ottenendo una quasi completa esclusione dal circolo dell'aneurisma.

Al controllo a sei mesi la situazione risultava immodificata, mentre a dodici mesi si osservava la riabilitazione del terzo medio dell'aneurisma con ulteriore sfiancamento della sacca. Veniva praticato allora intervento di by-pass carotide cerebrale media con safena e l'aneurisma con il moncone sottostante di carotide riempiti con GDC; la cerebrale anteriore di sinistra era nutrita tramite comunicante anteriore.
Attività del Gruppo di Studio “Traumatologia Cranio-Spinale”
Authors: Palmieri A.
Published: April 2015

The Study Group of Cranio-Spinal Trauma was founded in 1995. The aim of the Group is to improve the knowledge of physiopathology and biomechanics of traumas and to assess the most effective diagnostic procedures. That's why a strict link with the omologous group of the Italian Society of Neurosurgery has been promoted. The first meeting on “Diagnostic Imaging of Spinal Trauma” has been held in Naples (May 97) with the participation of 150 people; various radiological aspects of lesions as well as legal problems and organization of trauma care have been treated. The Group is now partecipating to the book on “Radiological Guide-Line in Emergency Medicine”.
Aspetto infartuale cerebellare nella fenilchetonuria. Segnalazione di un caso
Authors: Pardatscher K. , Fera F. , Armentano A. , Bartone P. , Concolino D. , Cecere G. , Strisciuglio P.
Published: April 2015

A 14-year-old girl with phenylketonuria, detected by neonatal screening and ever since on a special diet, was investigated by magnetic resonace imaging of the brain. Changes were confined mainly to the posterior fossa with an aspect of multiple cerebellar infarctions which seem to be related to an early post-transfusional embolic event.
Schwannoma del ganglio genicolato simulante una lesione intrassiale temporale Segnalazione di un caso
Authors: Pardatscher K. , Ceccotti C. , Fera F. , Armentano A. , Bartone P.
Published: April 2015

We describe a surgically proved case of a schwannoma originating at the geniculate turn of the facial canal and presenting as a huge intracranial temporal mass.
Encefalopatia di Wernicke: Aspetti RM e revisione della letteratura Segnalazione di un caso
Authors: Angileri T. , Banco A. , Sparacia G. , Pappalardo S. , Manfrè L.
Published: April 2015

L'encefalopatia di Wernicke è patologia legata a deficit di tiamina, conseguente spesso ad alcolismo cronico, che presenta peculiari localizzazioni encefaliche e conseguenti manifestazioni cliniche.

Viene descritto un caso di encefalopatia di Wernicke in un uomo di 25 anni, non alcolista, valutandone le lesioni alla risonanza magnetica in fase acuta e seguendone l'evoluzione.

Il paziente, con anamnesi patologica prossima di colite amebica, presentava un progressivo e rapido deterioramento delle capacità cognitive preceduto da una severa ipoacusia e riduzione dell'acuità visiva, discromatopsia, allucinazioni visive, prosopoagnosia, disartria.

Viene eseguita una RM dell'encefalo (con apparecchio Vectra, GE, operante a 0,5 T; sequenze SE DP e T2 ponderate e T1, prima e dopo Gd-DTPA) che evidenzia aree lesionali espresse da iperintensità, nelle sequenze a lungo TE, dei corpi mammillari, dei tubercoli quadrigemelli inferiori e (segno semeiologico, per quanto risulta da una revisione della letteratura, non descritto in precedenza tra i reperti dell'encefalopatia di Wernicke) dei tratti ottici. Ad una decisa integrazione alimentare con tiamina segue un repentino miglioramento clinico. Esami RM seriati rivelano una netta riduzione dell'estensione e delle alterazioni dell'intensità di segnale delle aree precedentemente coinvolte fino alla totale normalizzazione dei reperti.

Viene discussa la clinica, l'istologia e la presunta patogenesi dell'elettiva localizzazione del danno da carenza di tiamina a carico dell'encefalo, e gli aspetti neuroradiologici, individuando il ruolo dell'RM nell'iter diagnostico di tale patologia.
La RM nelle sequele dei traumi spinali
Authors: Pellicanò G. , Caracchini G. , D'Andrea M. , Bartolucci M. , Del Seppia I. , Cellerini M. , Mizzau M. , Dal Pozzo G.
Published: April 2015

From January 1990 to April 1997 we retrospectively evaluated 90 patients with MR examinations at our Spine Unit. The following post-traumatic spinal cord lesions were diagnosed: atrophy (47 pts), myelomalacia (40 pts), cysts (14), syrinx (14) and medullary transection with adhesion(4 pts). MR was very useful to identify atrophy more frequently found at the cervical-thoracic level (C6-D3). Myelomalcia was found in a patient with severe vertebral body trauma with chronic compression of the spinal cord. Intramedullary cysts were found in patients with hematomyelia in acute phase and were stable lesions. Post-traumatic syringomyelia is the most important sequela due to the fact that is often correlated with symptoms. MR not only detected the lesion but also identified intramedullary cavities without new neurological symptoms and guided surgery and follow-up. MR is the examination of choice not only for diagnosis of chronic spinal cord lesions but also to evaluate the possibility of surgical treatment.
Idrocefalo normoteso: Valutazione comparativa tra studi di dinamica liquorale mediante TC e RM
Authors: Bonamini M. , Gallucci M. , Simonetti L. , Alagia M.G. , Gagliardo O. , Cardone G. , Paluello G.B. Minio , Castrucci M.
Published: April 2015

Aim of this study was to evaluate the sensitivity of MR dynamic Bolus Tracking technique versus CT-cysterno graphy in Normal Pressure Hydrocephalus (NPH).

Seven patients (age 64–76 yrs), clinically suspected of NPH, were retrospectively evaluated. They had been submitted to CT-cysternography, MR dynamic Bolus Tracking technique in the acqueduct (cardiac-gated flow direction evaluation by means of 12–16 FFE T2*-w acquisitions per cardiac cycle, on sagittal plane along the acqueduct, with presaturation perpendicular to the acqueduct) and finally to surgical evaluation and subsequent ventriculo-peritoneal shunt.

MR showed in all cases altered cerebrospinal fluid (CSF) dynamics: 5 patients showed CSF reflux in the third ventricle during all cardiac cycle, in 2 patients an increased ejection rate through the acqueduct and into the cisterna magna was found. CT-cysternography showed CSF dynamics alterations only in 4 cases.

MR dynamic Bolus Tracking technique has proven to be more sensitive than CT-cysternography in the evaluation of NPH. Even though this study has to be considered preliminary, we believe that this simple and noninvasive technique should be recommended when NPH is suspected.
Ruolo della risonanza magnetica nella neuropatia periferica canalicolare non traumatica dell'arto superiore
Authors: Lupo F.A. , Paladini A.
Published: April 2015

La sindrome da neuropatia periferica canalicolare non traumatica è un'affezione relativamente frequente e può rappresentare il risultato di numerose noxe che direttamente o indirettamente agiscono su segmenti di nervo che percorrono canali osteo-fibrosi.

In tali strettoie il nervo, struttura più vulnerabile, può subire fenomeni meccanici di frizione o di pressione che, agendo sui vasa nervorum possono produrre ipossia, anossia, ischemia del nervo.

Viene riportato lo studio di 31 pazienti affetti da sindromi canalicolari spontanee non traumatiche degli arti superiori.

Viene sottolineato il ruolo svolto dalla RM nell'analisi morfologica dei singoli casi, i cui risultati correlati ai reperti clinici ed elettrofisiologici, possono essere utilizzati quale parametro di gravità nella valutazione prognostica e nella programmazione terapeutica della sindrome.
Correlazione RM-istopatologica del potenziamento periferico delle ernie discali
Authors: Aprile I. , Pizzolitto S. , De Nardi F. , Del Fabro P. , Iaiza F. , Petralia B. , Fabris G. , Leonardi M.
Published: April 2015

We found ring enhancement in 10 patients with lumbar disc herniation examined with magnetic resonance. In 5 cases histological examination showed peri-discal granulation tissue. The peripheral enhancement found in some cases of disc herniation is caused by inflammatory granulation tissue.
Reperti RM in pazienti con deficit di GH
Authors: D'Amico A. , Caranci F. , Simonetti L. , Zona G. , Salerno M. , Di Maio S. , Cirillo S. , Elefante R.
Published: April 2015

MR is able to depict anatomic details of the abnormality in hypothalamic-pituitary region.

We report the results in 30 prepurbertal, hypopituitary subjects, aged 6 months-14 years.

We analyzed:

the MR patterns and their distribution in the patients; the prevalence of “birth traumas” in this group; the prognostic value and the ability to relate to clinical and hormonal data of the MR features
Analisi economica del costo dell'indagine RM effettuata con tomografi di diversa intensità
Authors: Coppola V. , Memoli L. , Brunese L. , Alfinito M. , Coppola M. , Vallone G.
Published: April 2015

Indipendentemente dalle prestazioni, sono stati valutati e confrontati i costi di gestione e di ammortamento di due apparecchiature per risonanza magnetica da 1 e 0,5 Tesla e si è ricavato il costo-medio per esame.

Le condizioni lavorative sono state rappresentate in maniera ideale e i tempi tecnici standardizzati.

Le nuove modalità di rimborso a prestazione, basata sulla verifica dei DRG deve obbligare a una preventiva valutazione strategica delle risorse da impiegare e dei costi da sopportare ai fini del raggiungimento del break even point.

La modalità procedurale seguita deve rientrare nella pianificazione strategica delle risorse che tutte le amministrazioni devono effettuare preliminarmente alla indizione di una gara d'appalto.
Intra-Ocular Lymphoma with and without CNS Involvement: Diagnosis and Follow-up a Report of 15 Cases Studied by MR
Authors: Gerber S. , Reux I. , Cassoux N. , Soussain C. , Fardeau CH. , Deladoeuille M. , Marro B. , Le Hoang Ph. , Marsault C. , Leblond V.
Published: April 2015

In order to assess the value of MRI in the diagnosis and follow-up of intra-ocular lymphoma, a rare form of primary non-Hodgkin's lymphoma of the central nervous system, we retrospectively reviewed fifteen patients.

All patients had ophthalmic investigations and 13 underwent ocular sampling. MR examinations of the brain and globes were performed in all cases and five patients underwent stereotactic brain biopsy. Six patients were treated with chemotherapy and/or radiotherapy, and nine with high-dose chemotherapy, followed by autologous bone marrow transplantation in five cases. MR follow-up was available in all cases.

All 15 patients had chronic uveitis which preceded the diagnosis and abnormal funduscopic findings. Three had a mild or severe neurologic deficit. Initial MRI showed brain lymphoma lesions in six cases and a choroido-retinal tumour in one. MR brain lesions were multiple in four cases. They appeared as contrast-enhanced infiltrating areas (n=11) or expansive masses (n=3); two lesions appeared as infiltrating high-signal T2 areas but were unenhanced on T1 with GdDTPA.

The diagnosis was based on vitrectomy in 11 cases and on stereotactic brain biopsy in four. Of the twelve lumbar punctures which were performed one was positive. Contrast enhancement disappeared during treatment in all cases, but isolated signal abnormalities persisted. The long-term outcome of such lesions in patients with an intact blood-brain barrier is not yet known. Ocular relapses occurred in 14 patients and CNS recurrences in four. Three patients died from CNS failure (n=1) or relapse (n=2), five are alive in partial remission, five are in complete remission and two died in remission from other causes. Follow-up ranges from 12 to 78 months (median 36 months).

MRI usually failed to detect intra-ocular lesions but identified clinically occult brain lesions and served to guide stereotactic brain biopsy when other samples were negative. MRI is the most sensitive follow-up method during treatment, even when the blood-brain barrier is intact.
Morphology and Development of the Spine: Plea for a Doubt
Authors: Roth M.
Published: April 2015

Growth and development of the vertebral column cannot be understood without taking into account its closest link with the “leading” cogrowth of its neural content. The phylogenetically established degree of outgrowth of that content determines the length of individual vertebrae and of the vertebral envelope in whole. Impairment of spinal neural growth leads to neuroadaptive transformation of vertebral shape in the sense of neuroadaptive shortening.

Insufficient spinal neural growth during the developmental period is paralleled by involutional atrophogenic shortening of the spinal nerve roots in the aged with essentially analogous response of the vertebral envelope, viz., profound and sometimes bizarre neuroadaptive “deformities” in the course of development, neuroadaptive “degenerative” narrowing (i.e. shortening) of the disc space(s) in the course of aging. Owing to the craniocaudally proceeding growth in length of the axial organ the neuroadaptive shortening in both instances is accomplished as though “from below”.
Arthrosis: The Last Defence?
Authors: Simonetti L. , Barbara C.
Published: April 2015

Can vertebral arthrosis be construed as the body's decision to privilege the spine's static function over its dynamic role when joint “hypermobility” linked to chronic load in old age could cause severe structural damage to the bony vertebral structures?
Why Does Disc-Root Conflict Generate Pain?
Authors: Simonetti L. , Agati R.
Published: April 2015

Root compression alone does not fully account for root pain following disc-root conflict, but it is nonetheless considered the main cause of pain. This short paper aims to explain that the origin of pain is multifactorial and inflammation probably predominates over merely mechanical mechanisms.
Angioplastica carotidea
Authors: Puglioli M. , Padolecchia R. , Collavoli P.L. , Parenti G. , Orlandi G. , Paoli C.
Published: April 2015

L'endoarteriectomia, come confermano i risultati degli studi multicentrici NASCET (North American Symptomatic Carotid Endarterectomy Trial), ECST (European Carotid Surgery Trial) ed ACAS (Asymptomatic Carotid Atherosclerosis Study), rappresenta il trattamento di elezione delle stenosi aterosclerotiche interessanti il distretto extracranico dell'arteria carotide, sia nei pazienti sintomatici (stenosi > 70%) che asintomatici (stenosi > 60%). L'intervento chirurgico è gravato da un rischio cumulativo di morbilità-mortalità (stroke/morte) che il NASCET, l'ECST e l'ACAS segnalano, rispettivamente, nel 5,8%, 7,5% e 2,3%, insieme ad altre possibili complicanze: infarto miocardico (0,9%), paralisi di nervi cranici (7,6%), ematoma del collo (5,5%), infezioni (3,4%).

Qualora, per ragioni cliniche od anatomiche, il rischio chirurgico sia troppo elevato, come nei pazienti cardiopatici, diabetici, con insufficienza polmonare o renale, con restenosi, con stenosi post-attiniche o fibrodisplastiche, con stenosi carotidee prossimali o distali, con lesioni «tandem», l'angioplastica transluminale percutanea (PTA) e/o lo Stenting carotideo possono rappresentare una valida alternativa terapeutica all'endoarteriectomia. In questo articolo presentiamo la nostra casistica relativa a 41 procedure (36 PTA; 5 Stenting), eseguite su 33 pazienti negli ultimi due anni. I trattamenti sono stati rivolti a 28 arterie carotidi interne, 4 arterie carotidi esterne, 2 arterie carotidi comuni, 2 tronchi anonimi; gli stents sono stati rilasciati in 4 arterie carotidi interne e in 1 arteria carotide comune.

Le procedure regolarmente portate a termine sono state 37 (32 PTA; 5 Stents), con un ottimo risultato anatomico in 36 casi. Nei controlli a 6 mesi abbiamo riscontrato una ristenosi (< 60%), asintomatica. In questo articolo illustriamo il nostro protocollo, gli insuccessi tecnici, i risultati e le complicanze.
Cerebral Leptomeningeal Angiomatosis CT and MRI evaluation
Authors: Tsitouridis J. , Stamos S. , Demertzis J. , Nikolopoulos P.
Published: April 2015

Leptomeningeal angiomatosis is an uncommon benign hamartomatous lesion usually involving the leptomeninges with or without cerebral cortex involvement.

Three middle-aged patients with seizures from adulthood had undergone CT and MRI examinations and craniotomies which revealed leptomeningeal angiomatosis. Another two young patients with Sturge-Weber syndrome and leptomeningeal angiomatosis were also evaluated.

MRI is clearly helpful in establishing the topography and vascular malformative nature of the lesion, while CT is more accurate in detecting vascular calcifications.
Cerebral Venous Sinus Thrombosis: Prognostic and Therapeutic Significance of an Early Radiologic Diagnosis
Authors: Roncallo F. , Turtulici I. , Arena E. , Bisio N. , Inglese M. , Assini A. , Gasparetto B. , Bartolini A.
Published: April 2015

We describe the CT and MRI patterns of cerebral venous sinus thrombosis (CVST) on the basis of the venous angioarchitecture and the underlying pathophysiological mechanism. We also investigated if any radiologic data exist to establish which patients can be followed conservatively and which warrant endovascular treatment.

The clinical, CT-CTA and MRI-MRA findings of 11 patients (2 men; 9 women; 24 to 69 years-old) with CVST were reviewed. The morphological patterns of CVST were divided into two major groups: Vascular signs: spontaneous sinusal hyperdensity (9); spontaneous all-sequences hyperintensity (4); venous engorgement (9); empty delta sign (4); lack of sinusal contrast-enhancement (3); delayed sinusal transit-time (11); lack of flow-related signal (3). Parenchymal signs: mass effect and cortical sulcal effacement (8), white matter edema (7), venous ischemia (6), haemorrhagic infarct (3), breakdown of the blood-brain barrier (4), hydrocephalus (2).

The clinical and radiologic pictures are related to cerebral venous angioarchitecture and underlying pathophysiologic mechanism of venous thrombosis. Reversibility of clinical symptoms and parenchymal lesions is far more frequent, because vessel damage slowly and progressively develops, whereas damage to brain tissue occurs later. Consequently, a prompt CT-MRI diagnosis may allow a good prognosis. Treatment using selective sinusal instillation of urokinase is considered only when the patient clinically and radiologically does not improve within the first two weeks after heparinization.
Low Dose Contrast Helical CT in Nodal Staging of Head and Neck Tumours
Authors: Dobrocky I. , Kemka S. , Rohac L. , Hudec P.
Published: April 2015

The aim of the study is to evaluate the accuracy of helical CT with low dose contrast in the nodal staging of head and neck tumours. Fifty-one patients were included in the study. 1 ml/kg of body weight of 300 mgI/ml contrast was injected at a rate of 1.5 ml/s. The total volume ranged according to the patient's weight between 45 and 100 ml (mean 70 ml). Axial diameter of 15 resp. 10 mm was set as a criterion for malignant involvement. The overall sensitivity for detection of malignant nodes was 92%, specificity 88%, accuracy 90%. The overall accuracy in nodal staging was 90%, sensitivity 96%, specificity 80%. The quality of contrast enhancement was scored with 2.5 on a 3 point scale (1-poor, 2-good, 3-excellent).

The sensitivity, specificity and accuracy in detecting metastatic lymph nodes with this technique in patients with head and neck cancer is comparable to studies performed with high dose. The maximal axial diameter of the LN is a suitable parameter for the daily routine.
MR Features of Lissencephaly with Clinical Correlations
Authors: Razek A. Abdel Khalek Abdel , Kandeel A. Y. , Baseet A.M. Abdel
Published: April 2015

We aimed to demonstrate the MRI features of lissencephaly and to correlate these features with associated anomalies and clinical features in an attempt to classify them. This study included eight infants with lissencephaly. They presented with seizures, hypotonia, microcephaly, large head or failure to thrive. They were examined using a 1.5 Tesla scanner. Both T1 and T2 weighted scan were done.

Our patients showed a smooth surface of both cerebral hemispheres with complete loss of gyri and sulci (agyria) (n=5) or agyria with areas of pachygyria (n=3). The cortex was thickened with thinning of the underlying white matter and loss of normal grey-white matter interdigitations (n=8). A shallow Sylvian fissure with hourglass or oval configuration of the brain was also noted (n=8). A linear cortical band of low SI on T1 WI and high SI on T2WI was noted in five cases. Other associated findings included: Dandy-Walker malformations (n=5), hydrocephalus (n=4), microcephaly (n=2), callosal agenesis (n=2), occipital encephalocele (n=1), microphalamia with retinal dysplasia (n=1), absent septum pellucidum (n?1) and colpocephaly (n=1). MR imaging is the imaging modality of choice for the demonstration of the pathognomonic features of lissencephaly. It helps the classification of lissencephaly into different types according to their MR appearance, associated anomalies and clinical features.
Congenital Cytomegalovirus Infection and Brain Anomalies
Authors: Sener R.N.
Published: April 2015

The spectrum of brain anomalies caused by cytomegalovirus (CMV) infection is discussed. Seven patients (four girls, three boys, ages ranging from 2 to 14 months) are included in this study. In the children and mothers serologic tests studied for CMV infection including IgG and IgM titres, and viral cultures for inclusion bodies, were positive. Cranial CT and MR imaging studies were performed. In all the patients, periventricular calcifications were evident on CT scans. CT and MR imaging revealed three patients with neuronal migrational disorders (pachygyria (n?2), and schizencephaly (n=1)). One patient had hydranencephaly. Of particular note, there were two patients with rhombencephalosynapsis, and one with Joubert's syndrome. CMV infection is known to cause some of the disorders of neuronal migration and organization in early gestation, and some encephaloclastic lesions (e.g. hydranencephaly) in late gestation. Its possible association with relatively rare cerebellar malformations (Joubert's syndrome, and rhombencephalosynapsis) as noted in this study, indicates further clinicoradiologic studies.
Brain MR Imaging Findings in Rare Skeletal Dysplasias
Authors: Sener R.N.
Published: April 2015

Brain changes in six patients with rarely encountered skeletal dysplasias are included in this study They had whistling face syndrome, Rubinstein-Taybi syndrome, Trisomy 13, dysosteosclerosis, polyoligodactyly/imperforate anus/vertebral anomalies (PIV) syndrome, and ectodermal dysplasia. The patients were studied by CT, and MR imaging. The distribution of the cerebral changes comprised cortical dysplasia (n=2), abnormal cortical infoldings with normal cortical thickness (n=1), retarded white matter myelination (n=2), callosal dysgenesis (n=1), dilated lateral ventricles (n?2), and cystic dilatation of Virchow-Robin spaces (n=1).
Tumori in collisione
Authors: Cervoni L. , Colonnese C. , Gagliardi F.M.
Published: April 2015

L'occorrenza simultanea di un meningioma e di un glioblastoma giustapposti è rara. Nei casi riportati in letteratura, la TC non permette la diagnosi preoperatoria, mentre la RM non è stata eseguita. Due tumori di differente istologia in giustapposizione sono stati evidenziati in una donna di 72 anni non affetta da malattia di von Recklinghausen. Essi erano un meningioma ed un glioblastoma e la RM preoperatoria non ne ha permesso la diagnosi.
Fluid-Fluid Levels in Benign Neurogenic Tumours
Authors: Patankar T. , Prasad S. , Pardiwala D. , Gupta S. , Goel A.
Published: April 2015

Though cystic neurogenic tumours are not uncommon, fluid-fluid levels are distinctly rare. We describe the imaging findings of fluid-fluid levels in two neurogenic tumours, one in a mediastinal cystic schwannoma in a patient with multiple schwannoma and another in a cervical neurofibroma.
MRI Changes in Cerebrotendinous Xanthomatosis after Treatment with Chenodeoxycholic Acid
Authors: Lui C.-C. , Chang W.-N.
Published: April 2015

We report serial changes in MRI findings in three siblings of biochemically and clinically proven cerebrotendinous xanthomatosis (CTX) after treatment with chenodeoxycholic acid (CDCA) 750 mg/day orally for seven years.

Clinical and electrophysiological studies are also assessed. Electroencephalography (EEG) has improved dramatically, whereas the magnetic resonance image (MRI) shows only slight change.
Proton Magnetic Resonance Spectroscopy of the Basal Ganglia in Idiopathic Focal Hand Dystonia
Authors: Warmuth-Metz M. , Naumann M. , Hillerer C. , Reiners K. , Pabst T. , Solymosi L.
Published: April 2015

Several findings point towards the lentiform nucleus as a possible lesion site in primary dystonia. Histological examinations, however, have shown inconsistent results. 1H-Magnetic Resonance Spectroscopy (1H-MRS) has proved helpful to assess neuronal degeneration in a variety of basal ganglia disorders. MRS data of dystonia patients, however, have not been reported so far. 1H-MRS centered on the lentiform nuclei was performed in 14 patients with primary focal hand dystonia and in 12 healthy controls. No statistically significant differences of metabolite ratios were found between patients and controls. Based on these data, primary focal dystonia does not seem to be associated with a conspicuous loss of lentiform nucleus neurons or a marked disturbance of the aerobic metabolism.
Distribution of White Matter Lesions in Multiple Sclerosis and Systemic Lupus Erythematosus
Authors: Peltz M.T. , Casciu L. , Manconi F.M. , Sanna G. , Schiffini P. , Mathieu A.
Published: April 2015

To evaluate the ability of brain MRI SE sequences to differentiate between SLE and MS we reviewed the brain scans of 30 SLE patients (30 female, mean age 38.5 +/-12 years) and of 30 definite MS patients (23 female, 7 male, mean age 35.5 +/- 8 years).

We analyzed the number and location of white matter lesions (WML) and classified them in different regions. We also pointed out associated brain abnormalities, such as large hemispheric lesions. We found periventricular, paraventricular and subcortical WML in MS and paraventricular and subcortical WML in SLE; a confluent pattern of WML was seen only in MS; infratentorial WML were more frequent in MS; corpus callosum involvement was found only in MS; large hemispheric areas of increased signal representing strokes were present only in SLE. MRI shows different lesion patterns in MS and SLE and may play an important role in the differential diagnosis between these diseases.
Development of Radiology Markers to Assess Clinically Diagnosed Chronic Fatigue Syndrome
Authors: Sarkar S.N. , Seastrunk J.W.
Published: April 2015

We demonstrate how to achieve a high degree of radiologic correlation in the diagnosis of chronic fatigue syndrome and add differential diagnosis to clinically suspected patients by means of SPECT, MR and MR spectroscopy together with neuropsychiatric evaluation.
Interventional Brain Procedures Performed with Interactive MR-Guidance in the Open MR System
Authors: Kollias S.S. , Bernays R. , Christoforidis G.A. , Yonekawa Y. , Valavanis A.
Published: April 2015

We aimed to develop a pre-procedural imaging protocol which provides functional and anatomic information for lesion characterisation and procedural planning and to determine appropriate sequence parameters for “real-time” intra-procedural tracking of interventional devices. 34 patients underwent MRI guided procedures using a 0.5 T open-bore magnet. Interactive “real time” imaging was accomplished with a 3D optical tracking system and specialised image guidance software implemented on an interactive workstation. Pre-procedural planning in a 1.5 T magnet included standard T1- and T2-weighted images, 3D target volume determination and segmentation analysis, 3D time-of-flight MRA, cerebral blood volume mapping, and functional cortical mapping. Intra-procedure imaging included baseline and final T1- and T2-weighted imaging and interactive T1-weighted RF-spoiled GE images acquired every 4 sec for contrast enhancing lesions; or T2-weighted SSFSE images acquired every 3 sec, for nonenhancing lesions. Pre-procedural imaging offered precise anatomic, functional and volumetric definition of the target, eloquent brain, skull surface and surrounding vessels for appropriate burr hole placement and trajectory planning. MR perfusion offered tissue characterisation and margin definition not evident with conventional MRI. Real time imaging helped avoid vascular structures and eloquent brain without complications, always yielded diagnostic biopsy tissue and showed progressive collapse of necrotic tumors, abscesses, and hematomas with relief from mass effect. On-line imaging during excision of an infiltrating glioma allowed more confident tumor margin estimation. Improved pre-procedural image acquisition and processing and on-line imaging in an accessible MR system allows real time procedural monitoring increasing its accuracy, safety and diagnostic and therapeutic yield.
MR Imaging of Brain: Comparison between SS-FSE and Fast Spin-Echo T2-Weighted Pulse Sequences
Authors: Seo Jeong-Jin , Kang Heoung Keun , Jeong Gwang-Woo , Jeong Yong-Yeon , Kim Jae-Kyu , Park Jin-Gyoon , Chung Tae Woong , Kim Yun Hyeon
Published: April 2015

We compared quantitatively and qualitatively a single shot fast spin-echo (SS-FSE) technique with a T2-weighted fast spin-echo (T2-FSE) technique and to determine whether SS-FSE is a valuable alternative to fast SE (FSE) imaging. A total of 41 consecutive patients with brain lesions were retrospectively evaluated. Together with quantitative analysis, contrast-to-noise ratios (CNR), signal-to-noise ratios (SNR), and the percent contrast (%C) were measured for the lesion. Images were evaluated by two radiologists who reached consensus. Visibility (detection), margination, and extent of the lesions were rated separately, according to a five-point scale. The mean lesion CNR was significantly higher on SS-FSE sequences than on fast SE sequences (p=0.0131). The mean lesion %C was also higher on SS-FSE than on T2-FSE sequence (p=0.0222). However, the mean lesion SNR was significantly higher on T2-FSE sequence than on SSFSE sequence (p?0.0222). No significant differences were found in the visibility (detectability) of the lesions between two pulse sequences (p=0.1323). The SS-FSE technique is quantitatively superior to T2-FSE for obtaining T2-weighted images of the brain. In comparison with T2-FSE, SS-FSE provides comparable T2-weighted images with sufficient contrast in the evaluation of brain lesions. Our findings suggest that SSFSE may be useful for ill, uncooperative patients, especially for the children patients requiring sedation.
Group Average Activation Maps of Functional MRI: Methodology of Identifying Group Brain Areas Activated during Painful Thermal Stimuli, Motor and Vibrotactile Tasks in Humans
Authors: Krauss B. , Apkarian A.V.
Published: April 2015

Pain perception activates a complex network of cortical regions. The functional specializations of the various components comprising this network remain for the most part unknown. Moreover, the cortical networks described for pain perception include cortical regions involved in touch perception, and motor execution. We performed functional MRI (fMRI) studies to compare between cortical networks activated during a thermal painful stimulation with cortical networks activated during vibrotactile, and motor tasks. The fMRI scans for all three tasks were done in every subject, in single scanning sessions. This procedure enables the comparison between activation maps in individual subjects. A group average activation map was necessary to compare our fMRI results with earlier positron emission tomography (PET) studies of thermal pain, most of which have been based on group averages, and in order to examine the task dependent brain activations within a population of normal subjects. Here we describe the methodology developed for generating fMRI population activation maps.
FMRI of the Cerebellum: Rostral Paravermal Activation in Tongue and Lip
Authors: Gawehn J. , Hunsche S. , Urban P.P. , Marx J. , Hopf H.C. , Stoeter P.
Published: April 2015

We investigated with fMRI the cerebellar representation of articulatory vertical movements of the tongue and orofacial muscles in healthy volunteers and its correspondence to the area known to be affected in cerebellar dysarthria. fMRI stimulation is mainly unilateral in agreement with the frequent occurrence of dysarthria in unilateral infarction.
Functional MRI Study of Posterior Parietal Cortex in Visuomotor Tasks
Authors: Spelle L. , Dauchot K. , Anton J.-L. , Guigon E. , Burnod Y. , Pierto L.
Published: April 2015

The posterior parietal cortex is known to be involved in visuomotor task processing. Unsolved question are 1) whether a special cortical network is implied in pointing tasks or the same network is shared by other tasks with similar visual input and motor output 2) is there a hemispheric specialization in these treatments? Axial MR images were acquired in eight right-handed volunteers, using EPI sequence. Behavioral conditions were designed to perform two visiomotor tasks: a) pointing to a visual target, with the right or left hand; b) spatial detection of the visual target. Both tasks shared the same retinal input and motor output. The visual stimuli were generated by a computer and projected on a screen. Data processing included conditioned analysis and inter-subject comparison of different task activation extent and overlap in different cortical regions. Both tasks activated the same fronto-parietal network. Within this network, there was a significant cortical activation overlap between the pointing tasks performed with either hands, suggesting that a special treatment may be performed by the left parietal cortex for pointing tasks. An overlap between the detection task either with the right or the left hand was found in the right parietal cortex. Different visuomotor tasks involving the same reference frame transformations are performed by the same fronto-parietal network. The right parietal cortex may be specifically involved in detection tasks whereas the left parietal cortex would be specifically implied in processing of pointing tasks. These results are consistent with neuropsychological evidence from patients with parietal lesions.
Presurgical Mapping with Functional MR Imaging versus Transcranial Magnetic Stimulation Combined with Surface Anatomy Scanning
Authors: Morikawa M. , Kaminogo M. , Ochi M. , Ishimaru H. , Hayashi K.
Published: April 2015

Fifteen patients, who had tumors in or near the precentral gyrus, underwent functional magnetic resonance imaging (fMRI) and transcranial magnetic stimulation (TMS) combined with surface anatomy scanning (SAS) for presurgical mapping of the sensory motor cortex. TMS activated the motor cortex in all patients and fMRI demonstrated task activation of sensory motor cortex in 14 of the 15 patients. The marker of TMS superimposed on SAS and fMRI activation agreed within 0.5 cm in 11 of the 14 patients. In the remaining three, the distance of these mapped sites ranged from 1 cm to 1.5 cm, and SAS showed a deformity of the central sulcus which may cause the deviation of activated site with TMS. The cortical surface projection of TMS using SAS and fMRI has good spatial relationship and is useful in identifying a primary motor cortex in presurgical planning.
Contrast Agents for Cerebral Dynamic Susceptibility MRI Hemodynamic Effects after Intravenous Bolus Injection
Authors: Doerfler A. , Forsting M.
Published: April 2015

We investigated the effects of IV bolus injection of three MRI contrast agents, i.e., Gadolinium-DTPA, polylysine-Gd-DTPA and superpara-magnetic iron particles (SPIO) on arterial blood pressure and cerebral blood flow (CBF). In 56 anesthetized rats a single fiber laser Doppler flowmetry (LDF) probe was placed intracerebrally. CBF and mean arterial blood pressure (MABP) were measured before (baseline), during and up to 30 minutes after IV bolus administration of the three contrast agents: 0.1 mmol/kg and 0.3 mmol/kg Gd-DTPA (n = 18 per group), respectively, 0.3 mmol/kg polylysine-Gd-DTPA (n ? 10) and 0.03 mmol/kg SPIO (n = 10). Neither the higher nor the lower dose of Gd-DTPA had any statistically significant effect on CBF. There were no changes in blood pressure during administration of Gd-DTPA at both dose levels. Administration of polylysine-Gd-DTPA caused a transient drop in blood pressure in two animals; marked in one animal (decrease to 21% of preinjection values/baseline) and mild in another (84% of baseline). After administration of SPIO a significant decrease in blood pressure occurred in one animal (41 % of baseline). Despite this decrease in MABP, there were no statistically significant changes in CBF after administration of polylysine-Gd-DTPA and SPIO. Our results suggest that bolus injection of these contrast agents in clinically relevant doses causes no significant alteration in cerebral blood flow. We conclude that at least Gd-DTPA is well suited for cerebral MR perfusion imaging without inherent influence on CBF. The same is probably also true for polylysine-Gd-DTPA and superparamagnetic iron particles.