bluuebunny/crossref_metadata_2025 huggingface dataset:
Biopsia TC-guidata nelle lesioni litiche vertebrali
Authors: Facchinetti A. , Grivetta M. Audi , Baruzzi F. , Minonzio G. , Mercuri A. , Albertini F. , Bonaldi G.
Published: April 2015

Dal giugno 1991 all'agosto 1994 abbiamo sottoposto a biopsia vertebrale TC-guidata 24 pazienti, portatori di alterazioni litiche vertebrali o disco-vertebrali di natura non sicuramente determinabile in base ai dati morfologici lesionali ed al contesto clinico-diagnostico.

Due tipi prelievo sono possibili, citologico ed istologico, con tecnica differente, in particolare per quanto riguarda lo strumentario utilizzato.

In 15 pazienti abbiamo avuto un reperto di tipo neoplastico, in 10 secondario ed in 5 primitivo. In 5 il reperto è stato di tipo infettivo-infiammatorio. In 4 pazienti infine prelievi ripetuti non hanno fornito materiale sufficiente ad una corretta diagnosi. Nella nostra serie l'attendibilità diagnostica è stata quindi dell'83%.

Nei 24 casi da noi trattati non lamentiamo alcuna complicanza.

L'unica controindicazione assoluta alla metodica è la presenza di una grave coagulopatia.

In conclusione la metodica, grazie all'impiego della TC, risulta semplice, rapida e sicura; elevata è nella nostra esperienza l'efficacia a fini diagnostico-terapeutici.
Metastasi del midollo spinale: Studio RM
Authors: Milella D. , Tarantino A. , Andreula C.F. , Carella A.
Published: April 2015

Le metastasi intramidollari, con l'utilizzo della RM, stanno acquisendo sempre più una loro identità nosologica anche per il neuroradiologo, perdendo così la connotazione di patologia di interesse prevalentemente dell'anatomo patologo. La loro frequenza fra le complicanze di un processo neoplastico, è comunque sempre molto rara con un'incidenza infatti che varia dallo 0,9 all'8,5%. Questa rarità di riscontri neuroradiologici è in parte dovuto anche al mezzo tecnico «RM», che deve essere utilizzato sfruttando al massimo le sue potenzialità alla ricerca di queste lesione sovente molto piccole.

La neoplasia che più frequentemente realizza lesioni secondarie a livello del midollo spinale è il cancro polmonare, segue poi il cancro mammario, il melanoma, il linfoma, cancro del colon etc.

Il nostro studio è stato condotto con un'analisi retrospettiva di 165 esami RM spinali e midollari effettuati a pazienti con una neoplasia primitiva già diagnosticata o la cui diagnosi è scaturita proprio successivamente al riscontro neuradiologico. La sintomatologia di avvio all'esame era quasi sempre aspecifica, priva cioè di un indicazione precisa di sofferenza midollare, ma caratterizzata solitamente da dolore radicolare. Il nostro riscontro è stato di 6 metastasi intramidollari con una percentuale quindi di incidenza di lesioni intramidollari nella nostra casistica del 3,8%.

I nostri rilievi neuroradiologici sono stati caratterizzati da alterazione morfologica del midollo spinale, alterazione di segnale, o evidenziazione diretta della lesione dopo somministrazione di mdc.

La semeiotica neuroradiologica della lesione midollare sicuramente non patognomonica, ma ugualmente particolare, è comunque elemento indispensabile nell'ambito della diagnosi differenziale, con tutte le altre lesioni intramidollari, che bisogna sempre operare.

Tale patologia quindi deve sempre essere tenuta sempre in cosiderazione dal neuroradiologo ogni qual volta viene eseguita una RM del rachide e midollo per la ricerca di metastasi. RM che è da considerare senza alcun dubbio come esame di scelta nella ricerca di possibili lesioni secondarie intramidollari, ma che deve essere eseguita sempre con la massima accortezza e completata con somministrazione ev di mdc paramagnetico, in relazione alle dimensioni solitamente piccole di queste lesioni.
Valutazione della tossicità oculare e studio delle vie ottiche
Authors: Egitto M.G. , Uggetti C. , Zappoli F. , Sibilla L. , Martelli A. , Karau J. , Ceccuzzi R.
Published: April 2015

Tredici pazienti, affetti da glioma cerebrale maligno e sottoposti a chemioterapia intraarteriosa con Etoposide e Carboplatino, sono stati valutati prima e dopo i cicli di terapia mediante test oculistici oggettivi e soggettivi, al fine di evidenziare eventuali effetti tossici specifici provocati dai farmaci impiegati. Non si sono osservati effetti negativi sulla funzionalità oculare né sulle vie ottiche centrali. È dunque possibile somministrare i farmaci chemioterapici nel tratto sotto-oftalmico delle arterie carotidi, ottenendo una perfusione di vaste aree di tessuto cerebrale, ed aumentando così la possibilità di raggiungere con la terapia cellule tumorali infiltranti a distanza dal focolaio neoplastico.
La TC nello studio della patologia flogistica cronica rino-sinusale
Authors: Roncallo F. , Turturici I. , Bartolini A. , Tedeschi A. , Santelli A. , Di Santillo L. Scotto , Garaventa G.
Published: April 2015

Sono stati valutati gli aspetti morfologici delle flogosi croniche rino-sinusali alla TC, eseguita secondo un protocollo iniziale standardizzato, in funzione delle alterazioni anatomo-patologiche presenti, tenuto conto che le nuove tecniche chirurgiche più conservative presuppongono un dettagliato bilancio spaziale pre-operatorio.

La TC è tecnica in grado di documentare ispessimenti anche minimi della mucosa rino-sinusale, così come manifestazioni reattive ossee di tipo litico o sclerotico ed eventuali componenti essudative associate. Il dato fondamentale, tuttavia, da analizzare durante il corso dell'esame è rappresentato dall'integrità o coinvolgimento delle regioni del complesso ostio-meatale e del recesso sfeno-etmoidale.

Le flogosi croniche semplici sono state suddivise a seconda dei dati anatomo-morfologici emersi in tre forme, in accordo con i dati recenti della letteratura: infundibolare, ostiomeatale e sfenoetmoidale.

Tra le flogosi croniche complicate sono stati considerate le poliposi erosive e le cisti. Le poliposi erosive rappresentano la forma sintomatica più frequente, di cui sono state valutate sia forme iniziali, sia forme più avanzate, sia forme recidive, sia complicanze ascessuali. Nell'ambito della patologia cistica, le cisti mucose e sierose sono risultate assai frequenti, ma raramente sintomatiche, mentre forme flogistiche croniche cistiche di più raro riscontro quali il mucocele e mucopiocele sono state evidenziate in pazienti portatori di sintomatologia oculare ad andamento lentamente ingravescente.

Infine nelle forme croniche complicate sono state inserite le rare flogosi iatrogene.
Endovascular GDC Treatment of an Idiopathic Carotid-Cavernous Fistula Caused by Aneurysmal Rupture of the Intra-Cavernous Carotid Artery
Authors: Tatewaki Y. , Nishimura S. , Ezura M. , Nishino A. , Sasaki K. , Utsunomiya A. , Suzuki S. , Uenohara H. , Sakurai Y.
Published: April 2015

Aneurysmal rupture of the intra-cavernous carotid artery may cause idiopathic carotid-cavernous fistula (CCF), and the treatment choice for occluding shunting fistula in this type of CCF is an endovascular approach using detachable balloons. However, little has been reported on treating such lesions with the intra-aneurysmal embolization using Guglielmi detachable coils (GDCs). To our knowledge, ours is the first reported case of successful treatment by selective intra-fistula and intra-aneurysmal embolization with GDCs. A 74-year-old woman exhibited proptosis and chemosis of her left eye over a period of one month. Symptoms of double vision in conversion and pulsatile murmur in her left eye were also noted. Angiography revealed an intra-cavernous aneurysm of the left internal carotid artery (ICA) with a shunting fistula, which drained into the dilated cavernous sinus, superior orbital vein (SOV), superior petrosal sinus, inferior petrosal sinus, and pterygoid plexus. We thought the fistula would occlude by intra-aneurysmal embolization, but we had no confidence of tight packing of the aneurysm since the aneurismal neck was relatively wide. So, we embolized the venous side of the shunting fistula and then the dome of the aneurysm with GDCs. Immediately after the operation, her symptoms and signs were ameliorated, and complete occlusion of the CCF was observed on long-term follow-up. We suggest selective intra-fistula and intra-aneurysmal embolization with GDCs as an alternative method of treatment of idiopathic CCF originating from aneurysmal rupture of the intra-cavernous carotid artery.
The Stenting to Internal Carotid Artery Stenosis (ICS) in Petrous Portion
Authors: Hayashi K. , Seyama H. , Yamada N. , Murao K. , Iihara K. , Takahashi J.C. , Nakajima N. , Sayama T. , Morimoto M. , Mori H. , Yamamoto M. , Hishikawa T. , Nonaka Y. , Ayabe J. , Kikuchi T. , Hyuga M. , Ookawa M. , Kudo T. , Miyamoto S.
Published: April 2015

In the safety stenting, it is important to get to know the characteristics of a plaque. In petrous carotid artery stenosis, it is difficult to know the characteristics of the plaque. We paid our attention to the MPRAGE (Magnetization Prepared Rapid Acquisition with Gradient Echo) method on high resolving power MRI.

By the MPRAGE method, low intensity was observed in these lesions of all cases. This result suggested that the plaque in petrous portion was a fibrous plaque. This method is useful to get to know the characteristics of a plaque in petrous portion before endovascular treatment.

In the petrous carotid artery stenosis, only endovascular treatment is possible for recovering an antegrade blood flow. In a case uncontrollable by medication, endovascular treatment is an important therapeutic procedure and it is thought that the role will become large from now on. It is required to grasp the characterization of a plaque beforehand in order to treat more safety CAS. Characteristic diagnosis of the plaque using this MPRAGE method did not have an attack either, it is the procedure of doing simple, it was thought that qualitative diagnosis whether a plaque is hard at least or it is soft was attained, and it was thought that it was a useful procedure.

The MRI-MPRAGE method can expect the useful method for the investigation the plaque characterization of the petrous carotid artery stenosis.
Il conflitto neurovascolare come causa di ipertensione arteriosa
Authors: Medicamento N. , Carella A.
Published: April 2015

La RM è la metodica diagnostica d'elezione nello studio dei conflitti neurovascolari. Vi sono numerose indicazioni che pongono alla base dell'ipertensione essenziale la compressione della superficie anterolaterale sinistra dell'oblongata da parte di strutture vascolari arteriose.

Allo scopo di verificare questa ipotesi abbiamo esaminato 15 pazienti ipertesi mediante RM, utilizzando sequenze F.L.A.SH.-3D, che si sono dimostrate le più idonee a mostrare tali alterazioni.
Paralisi isolata del nervo ipoglosso
Authors: Albertini F. , Mercuri A. , Baruzzi F. , Minonzio G. , Facchinetti A.M. , Marra A. , Bonaldi G.
Published: April 2015

Vengono presentati quattro casi di paralisi isolata del nervo ipoglosso giunti recentemente alla nostra osservazione. In tre casi la sintomatologia clinica era conseguente ad una compressione del tronco nervoso a livello del canale osseo proprio (due da secondarismo di carcinoma mammario, il terzo da dissezione della carotide interna a livello del bulbo della giugulare). Nel quarto caso il deficit neurologico era in relazione con una poussée di sclerosi multipla.

Una paralisi isolata del XII è sintomo relativamente raro, spesso misconosciuto o sottovalutato. Al contrario la nostra esperienza e un'attenta analisi della letteratura mostrano come esso possa essere espressione di patologie a eziopatogenesi estremamente polimorfa, anche gravi e potenzialmente curabili. Il suo rilievo deve quindi indurre il neuroradiologo ad uno studio mirato di tutta la regione, il cui presupposto è rappresentato da una conoscenza approfondita anatomo-clinica, al fine di un corretto utilizzo delle specifiche metodiche diagnostiche.
MR Imaging of Congenital and Acquired Malformation of the Eye and Orbit
Authors: Manfrè L. , Banco A. , Accardi M. , D'Antonio V. , Caronia A. , Lagalla R.
Published: April 2015

As for all the central nervous system (CNS) defects, the severity of eye malformations is related to the time a teratogenic factor occurs: the earlier the insult, the more serious the eye abnormalities are.

Magnetic resonance imaging perfectly depicts most eye defects. Considering that several CNS malformations have been described to occur simultaneously in the case of eye abnormalities, MRI is considered the imaging modality of choice nowadays.
MR Imaging in Intrinsic Tectal Tumours
Authors: Sparacia G. , Pappalardo S. , Manfrè L. , Sarno C. , Angileri T. , Lagalla R.
Published: April 2015

This article presents some anatomic and neuroradiologic clues in the identification of intrinsic tectal tumours and the main related problems of differential diagnosis.

The majority of intrinsic tectal lesions are low-grade gliomas that have been recognized as a potential cause of late-onset aqueductal stenosis. The superb sensitivity of magnetic resonance (MR) imaging and its multiplanar imaging capability allow an optimal diagnostic accuracy in the tectal region. For this reason, MR imaging should be included in the work-up of all patients with neurological findings of brain stem dysfunction and late-onset aqueductal stenosis.

Tectal gliomas particularly merit an accurate MR long-term follow-up monitoring, since they may ultimately show evidence of progressive growth and require therapeutic intervention to maintain disease control.
Vertebral Lipoma
Authors: Angileri T. , Iovane A. , Coppolino F.
Published: April 2015

Intraosseous lipoma is a rare benign tumour of the skeleton. Despite equally occurring equally in men and women of all ages (5 to 75 y.o.), it is usually identified during the IVth-VIth decades of life.

Although these lesions can be entirely asymptomatic, approximately two thirds of patients with intraosseous lipomas have localized pain and variable amounts of soft tissue swelling. The pain can be continuous or intermittent at rest, increasing after physical activity. Pathological fractures rarely occur.

We describe a patient with vertebral lipoma studied with CT and MRI.

MRI can easily demonstrate the fatty nature of vertebral lipomas, thanks to the characteristic high signal intensity on T1 weighted Spin Echo scans and the saturation of fatty signal on fat-saturating sequences, providing an accurate assessment of the degree of lesion involution.
La RM nelle sequele dei traumi cranici
Authors: Pellicanò G. , Nistri M. , Beccani D. , Cellerini M. , Gallina P. , Dal Pozzo G.
Published: April 2015

Given the higher sensitivity of MRI and the recent advances in faster imaging techniques the purpose of the study was to obtain MRI findings in 70 patients who had suffered from a head injury with transient consciousness loss or prolonged coma at least 24 months before entering the study.

Multiplanar MRI offers invaluable advantages in the identification of the precise location of the sequelae of cranial traumas. In case of hemorrhagic lesions, the information capacity of CT progressively diminishes in relation to the absorption of the edema and bleeding, whereas MRI increases its sensitivity due to the paramagnetic properties of hemoglobin by-products. MRI allows the identification of a larger amount of small lesions, particularly those located at critical sites, as corpus callosum, temporal and frontal tips cortical surface. Using Fluid Attenuated Inversion Recovery (FLAIR) pulse sequences, a better delineation of cortical and subcortical lesions is permitted, with remarkable improvement of sensitivity when compared with conventional Spin-Echo images. Finally, adopting MRI has important implications from a medico-legal standpoint.
Indagine dinamica della circolazione liquorale con RM a contrasto di fase. Reperti normali e patologici
Authors: Duca S. , Crasto S. , Salzedo E. , Bertone P. , Peretta P. , Genitori L. , Mozzambani F.
Published: April 2015

The introduction of fluid motion sensitive MR sequences allows a physiologic evaluation of CSF circulation. The authors use a phase contrast MR sequence to evaluate the CSF flow in 48 patients (12 with ventriculostomy, 10 with Chiari malformations, 7 with aqueductal stenosis, 15 with various degrees cranio-ventricular malformatios, 3 with syringomyelia and 3 with normal pressure hydrocephalus.) The technique is particularly useful in the evaluation of the opening of ventriculocisternostomy. Some technical problems that can give a false negative examination are discussed.
Effetti dell'ipocapnia e dell'ipercapnia sul flusso liquorale acqueduttale e sul flusso ematico nel seno sagittale superiore. Studio quantitativo con Cine-RM contrasto di fase in soggetti normali
Authors: Santoni M. , Mascalchi M. , Cellerini M. , Cuttano A. , Dal Pozzo G.
Published: April 2015

The aqueductal CSF and superior sagittal sinus (SSS) blood flow were quantified in 9 healthy volunteers using a Phase Contrast Cine MR technique with retrospective cardiac gating and velocity of encoding of 10 and 30 cm/s.

All subjects were examined in basal conditions, during hypocapnia determined by sustained hyperventilation and during hypercapnia (>5%) obtained with rebreathing in a plastic bag. In basal conditions, the aqueductal CSF flow area showed a mean increase of 24% synchronous with the cerebral systole, whereas variations of the SSS flow area during the cardiac cycle were negligible (>9%).

The mean flow velocity and volume in the SSS were 11.7 cm/s and 236 ml/min. Mean peak systolic and diastolic aqueductal CSF velocity were + 2 cm/s and −2 cm/s. Hypocapnia determined in all but one subjects a decrease of the SSS blood and aqueductal CSF velocities.

During hypocapnia a decrease of the aqueductal CSF flow area was also observed. Hypercapnia was associated with a decrease of the SSS flow velocity in 3 subjects and to minor changes in the remaining 6 subjects. Hypercapnia determined an increase (up to 30%) in the peak systolic and diastolic aqueductal CSF flow velocity in 3 subjects, negligible changes in 5 subjects and a decrease of the same parameters in one subject. The aqueductal CSF flow area was decreased in 8 subjects during hypercapnia.

Hypocapnia and hypercapnia are relatively simple tests which can be used to modify the intracranial hydrodynamic equilibrium in healthy subjects. Further investigations are however needed before their application to the study of intracranial hydrodynamics in patients with hydrocephalus.
Valutazione RM con sequenze FLAIR e FFE del carico lesionale in pazienti affetti da gravi traumi cranici chiusi. Possibilità prognostiche
Authors: Pierallini A. , Pantano P. , Ferone E. , Zylberman R. , Pisarri F. , Vichi R. , Fantozzi L.M.
Published: April 2015

Our aim was to correlate MRI features with clinical outcome in 37 patients with severe head injury. All patients were submitted to neuropsycological evaluation and MRI when the consciousness status was adequate. MRI examinations were performed using a 1.5 tesla unit; in addition to T1, PD and T2-w spin-echo sequences, turbo-FLAIR and FFE sequences were also performed. FFE sequences are particularly sensitive to small hemosiderin amounts which may be missed by conventional SE, while turbo-FLAIR sequences provide the best depiction of the size of gliotic areas.

All the patients were submitted to neuropsycological reevaluation after 3, 6 and 12 months. Correlation between total and regional lesionai load and outcome was performed.

Our results showed that total lesion load at FLAIR and not at FFE was significantly correlated with clinical outcome. Frontal and temporal lobes were more frequently affected. Lesion size in the FLAIR images in the temporal lobe was significantly correlated with the level of consciousness at the first and second evaluations but it did not affect the long term clincal outcome.
Alterazioni corticali parietali nei disturbi del movimento: Evidenze in RM
Authors: Catalucci A. , Gallucci M. , Scarnati E. , Bonamini M. , Gagliardo O. , Cardone G. , Paluello G.B. Minio , Castrucci M.
Published: April 2015

Aim of our study is to present the findings of parietal cortex alterations in patients affected by movement disorders.

We observed 4 patients with movement disorders (3 parkinsonian syndromes, I diffuse dystonia) and MR evidence of cortical alterations, without additional cerebral lesions. MR was performed with a 0.5T unit, SE T1-w, TSE T2-w, and Turbo Fluid Attenuated Inversion Recovery (T-FLAIR) sequences on axial and coronal planes, contiguous slices and 5 mm slice thickness.

In the parkinsonian patients, parietal atrophy was observed in 2 cases and fronto-parietal atrophy in I case; in all cases T-FLAIR sequences showed bilateral parietal cortex signal alteration. The patient with diffuse dystonia presented severe bilateral parietal atrophy with bilateral fronto-parietal signal alteration.

Our findings are strongly suggestive for cortico-basal degeneration. The evidence of signal alteration within the cortex suggests a primary pathogenetic involvement of cortico-basal pathways.
I DRG in Neuroradiologia
Authors: Triulzi F.
Published: April 2015

Starting from January the first 1997 some crucial changes have happened in the Italian heath care system. A new reimbursement procedure was introduced for the public and private hospitals. This procedure coming from the American Diagnosis Related Groups system that was firstly assembled by the Insurance Companies as a method for evaluating the reimbursement according to the final diagnosis. This new reimbursement plan involves also neuroradiological procedures; an increasing solicitation of immediate reports can be easily predicted, even though each neuroradiological procedure will result as a cost for the solicitor.
Angio-TC: Stato dell'arte e sviluppi futuri
Authors: Faranna V.
Published: April 2015

The development of spiral acquisition techniques and the growing technology applied to both CT equipment and post-processing systems, have shown CT angiography (CTA), to be a complementary method to conventional Angiography, magnetic resonance angiography (MRA) or ultrasound, for the morphologic evaluation of vascular structures.

Through the administration via intravenous injection of a contrast media and by means of a fast acquisition of the Region Of Interest, we obtain the primary information to be processed and displayed according to various imaging techniques: Axial images, Multiplanar Reformatting (MPR), volume rendering (3D) or shaded surface display (SSD), Maximum Intensity Projection (MIP), Endoscopic-CT etc.

All of these processing methods, perform as a first step of the whole process, longitudinal interpolations by the data of the images.

Even though few methods to improve the quality of the images exist, among these the use of overlapping sections, the precision requires of the post-processing procedures to accomplish the medical requirements for diagnosis, is affected by a common factor which is the absolute anisotropicity of the acquisition voxel (dimension along the “Z” axis different and bigger than those in the transverse plane).

This represents the goal-parameter on which the various competitors will have to focus their efforts in order to obtain results with an improved diagnostic validity.

At present, the systems with dual-slice acquisition, represent the first step of what will be the acquisition technology of the future: “multi-slice”.

At the same time, the technologic growth of postprocessing workstations, will permit the development of new clinical applications combined with Spiral-CT acquisition which will broaden the horizons of modern medicine.
Angio-TC delle biforcazioni carotidee
Authors: Liboni W. , Rebaudengo N. , Avataneo T. , Coda R.
Published: April 2015

Knowledge of the natural history of atherosclerotic plaque at the carotid bifurcation, as well as the progression and regression of atherosclerosis, make it essential for a diagnostic approach more complete than angiography, whose only target is the degree of arterial stenosis.

Besides, the invasivity of the technique discourages repeated controls in a disease where the main risk factor is aging. Among non invasive techniques, Angio — CT shows good sensitivity and specificity compared to the conventional angiography, and the intraoperative and histologic data in 21 patients submitted to TEA of the 92 examined. Beside the entity of stenosis, Angio-CT can evaluate the endoluminal growth and structure of plaque.

Moreover, it provides a three dimensional representation of the region of interest. Reliefs emerge both from analysis of axial scans of the carotid bifurcation and from 3D and MP reformatting from raw data. Angio-CT data are integrated with results provided by Color Doppler-Ultrasonography in atherosclerotic screening.
Protocollo diagnostico non invasivo nelle stenosi carotidee
Authors: Turtulici I. , Roncallo F. , Giberti L. , Bartolini A.
Published: April 2015

Digital Subtraction Angiography (DSA) is now considered the elective diagnostic tool in the evaluation of carotid artery steno-occlusive pathology, although the use of intra-artery catheters implies some iatrogenic risk. Aim of the study is to evaluate the possible utilization of a flow-chart based on non-invasive diagnostic tools, such as Ultrasound (US) and Angio-CT in the pathology of neck vessels.

We retrospectively evaluated 35 pts with previous Transient Ischaemic Attacks (TIAs) in the carotid artery territory, aged between 38 and 67 years; 21 males, 14 females. The NASCET classification was used to quantify the entity of each carotid stenosis. All patients underwent neck US and Angio-CT; in 15 of them Angio-MRI and DSA were also performed. Angio-CT protocol implies volumetric acquisition from the C6 to the suprasellar region, 3 mm thick slices, 1.5 pitch, 100 ml TV c.m., 3 ml/20 s acquisition time, 1 mm axial image reconstruction, elaboration techniques: SSD, MIP.

US and Angio-CT images were comparated with Angio-MRI and DSA findings; according to the present study, axial, SSD, MIP Angio-CT images have the same accuracy as DSA in the evaluation of vessel course and stenosis degree; in the evaluation of the vessel course only they are comparable to Angio-MRI; in the quantification of the stenosis their reliability is the same as US. Angio-CT is more sensitive than DSA and MRI in the evaluation of parietal abnormalities.

The complementary use of US and Angio-CT techniques gives functional and anatomical information about extra-and intracranial carotid course, making invesigation possible also in uncooperative patients with minimal invasivity.
Trattamento percutaneo delle stenosi dei tronchi sovra-aortici: Esperienza multicentrica in Campania
Authors: Briganti F. , La Tessa G. , Cirillo S. , Sirabella G. , Saponiero R. , Napoli A.N. , Simonetti L. , Maglione F. , Tecame S. , Elefante R.
Published: April 2015

Nell'ambito della patologia stenotica dei vasi epiaortici la P.T.A. ha raggiunto un ruolo di primo piano; essa rappresenta il trattamento di prima scelta nelle stenosi delle origini delle arterie carotidi e succlavie.

L'introduzione di protesi endovascolari (stent) ha migliorato i risultati del trattamento endovascolare.

Questo lavoro valuta i risultati ottenuti da un gruppo di studio campano in tre differenti centri di neuroradiologia interventistica in quattro anni di attività sono stati trattati 35 pazienti affetti da patologia steno-ostruttiva del distretto epiaortico con un'età compresa tra i 60 ed i 72 anni.

La valutazione dei risultati pertanto è stata fatta sul controllo angiografico immediato e clinico-strumentale (echo-doppler) a distanza.
Angiografia RM a contrasto di fase delle fistole arterovenose durali intracraniche
Authors: Cellerini M. , Mascalchi M. , Ferrito G. , Mangiafico S. , Scazzeri F. , Olmastroni M. , Marin E. , Scardigli V. , Dal Pozzo G. , Quilici N.
Published: April 2015

Ten patients with native intracranial dural arteriovenous fistulae (DAVF) demonstrated by arteriography underwent MR imaging and phase contrast MR angiography before treatment. The DAVFs were of type I (n=2), IIa (n=l), II a+b (n? 3), and TV (n=4). Joint review of the arteriography, MR imaging and MR angiography hard copies was performed by two observers. MR imaging showed intracerebral hemorrhage in 2 patients and diffuse or focal white matter edema in 2.

Focal venous ectasias in 4 patients with type TV DAVF and dilated cortical vessels in 6 patients were recognized on MR images.

MR angiography enabled identification of the DAVF nidus in 2 patients, hypertrophic feeding vessels in 5 patients and cortical dilated veins in 8 patients. Steno-occlusive alterations of the dural venous sinuses in 6 patients were readily demonstrated on MR angiography. Moreover, in 3 patients with type II a+b DAVFs, reconstruction of image phase of MR angiography allowed identification of flow revers al in the dural sinuses near the DAVF.

Phase contrast MR angiography is a useful complement to MR imaging for identification and characterization of intracranial DAVF.
L'esame Spect nella patologia del SNC in età pediatrica: Esperienze preliminari
Authors: Ruggiero R. , Covelli E. , Carannante G. , Buonocore M.C. , Leone E.
Published: April 2015

I recenti progressi nella tecnologia Spect hanno prodotto un evidente aumento della sensibilità e della risoluzione dei sistemi di acquisizione ed elaborazione consentendo una estensione della applicazione della metodica a svariate patologie, particolarmente a quelle di pertinenza neurologica.

In età pediatrica la Spect ha, negli ultimi anni, fornito ulteriori informazioni nello studio delle epilessie. Noi abbiamo iniziato da alcuni mesi ad applicare la metodica nello studio di patologie del SNC della prima età pediatrica.

In questo lavoro vengono presentati i risultati preliminari e viene posta una iniziale verifica se i dati Spect, correlati con gli altri dati strumentali, possano essere utili nell'iter diagnostico di queste patologie.
Valutazione dello spettro di alterazioni ischemiche cerebrali in pazienti asintomatici affetti da talassemia e talasso-drepanocitosi: Valore della RM nel protocollo terapeutico
Authors: Manfrè L. , Accardi M. , Vaccaro G. , Raineri R. , Giarratano E. , Lagalla R.
Published: April 2015

La patologia ischemica rappresenta la causa principale di lesione cerebrale nei pazienti affetti da drepanocitosi, ed è stata documentata mediante RM nei pazienti affetti da stroke. Alterazioni ischemiche possono tuttavia avere luogo anche in assenza di una obbiettività clinica. Recentemente è stato dimostrato il ruolo della RM nella valutazione delle ischemie cerebrali in pazienti affetti da talasso-drepanocitosi e da talassemia. Scopo del lavoro è stato quello di analizzare le alterazioni presenti in una coorte di pazienti affetti da tali alterazioni.

20 pazienti al di sotto di 50 anni di età, affetti da talasso-drepanocitosi (età media 29.5) e 20 affetti da talassemia (età media 31.7), previo consenso informato, sono stati sottoposti ad una valutazione T1- e T2-ponderata a livello encefalico, mediante apparecchiatura operante a medio campo e bobina in quadratura. Due centri di ricerca per la talassemia sono stati coinvolti (Palermo, Caltanissetta), selezionando unicamente i pazienti con anamnesi negativa per pregressa sindrome neurologica acuta. Le lesioni ischemiche sono state valutate soggettivamente e classificate in piccole (<0.5 cm), medie (0.5 − 1.5 cm) e ampie (>1.5 cm) ed in singole o multiple.

Il 30% (6/20) dei pazienti affetti da talasso-drepanocitosi presentava multiple lesioni ischemiche con una prevalenza di lesioni medie o grandi 5/20 (25%). In un paziente veniva dimostrata la presenza di multiple malformazioni artero-venose leptomeningee, confermate al bilancio angiografico. Il 20% (4/20) dei pazienti affetti da talassemia presentava lesioni ischemiche piccole, singole in 2 casi (50%).

Il trattamento trasfusionale, per quanto non scevro di rischi, viene proposto oggi nei pazienti affetti da drepanocitosi colpiti da episodio ischemico cerebrale. Il trattamento dei pazienti asintomatici affetti da talasso-drepanocitosi non è al momento codificato: una valutazione sequenziale mediante RM potrebbe identificare i pazienti “a rischio” per incidenti vascolari, indirizzandoli alla terapia adeguata (idrossiurea, trapianto di midollo, trasfusione).
Spontaneous Intracranial Hypotension and MRI
Authors: Muras I. , Scuotto A. , Maisto M. , Bernini F.P.
Published: April 2015

Postural headache due to low intracranial pressure is a well-known entity and is most commonly encountered following lumbar puncture. It may occur as a consequence of a medical condition (dehydratation, uremia, etc.) but in some cases no precipitating event is apparent and the intracranial hypotension is believed to have developed spontaneously. In such cases the underlying cause of the syndrome is rarely established and treatment is non specific.

We describe three patients with spontaneous intracranial hypotension examined with MRI of the brain. Women are more commonly affected than men in the third or fourth decades of life. Schaltenbrand (1938) proposed three mechanisms by which spontaneous intracranial hypotension may be explained: diminished CSF production; CSF hyperabsorption, CSF leakage. The defect causing a CSF leak usually remains obscure. Several cases of diffuse meningeal enhancement on MRI have recently been described, probably due to meningeal hyperaemia resulting from the low CSF pressure. Subdural fluid collections have also been detected as a result of rupture of bridging veins due to the decrease in CSF volume and downward displacement of the brain.

In our cases, MRI showed a diffuse dural thickening, hyperintense in T2. Spontaneous intracranial hypotension is often a self-limiting disease, responding well to bed rest and a generous intake of oral or parenteral fluid and salt.
Infection-Associated Unilateral and Bilateral Carotid Artery Dissection
Authors: Amistà P. , Baracchini C. , Manara R. , Meneghetti G. , Carollo C.
Published: April 2015

Internal carotid artery dissection represents a rare cause of ischemic stroke and its pathogenesis remains unknown. Yet a probable contributing mechanism is infection-mediated damage to the arterial wall. We present two cases of unilateral and bilateral internal carotid artery dissection preceded by a pharyngitis and by a flu-like syndrome respectively. Both patients were investigated by computed tomography, magnetic resonance imaging and angiography, echo-color Doppler and transcranial Doppler. We emphasize the pivotal role of MRI and ultrasound in the diagnosis and follow-up of acute internal carotid artery dissection and suggest that an infection may act as a triggering factor.
Magnetic Resonance Angiography in a Case of Agenesis of the Left Carotid Artery Associated with Transellar Intercarotid Anastomosis
Authors: Gozzoli L. , Crasto S. , Leombruni S. , Bradac G.B.
Published: April 2015

Congenital absence or hypoplasia of the internal carotid artery is an extremely rare developmental abnormality. Usually these patients are asymptomatic because of functional compensation via the circle of Willis. A less frequent collateral circulation can occur by way of the primitive maxillary artery, an embrionic vessel originating from the controlateral carotid siphon and running through the sella turcica.

We describe a fortuitous finding of unilateral agenesis of the internal carotid artery with intercavernous anastomosis in a patient with a meningioma adhering to the lateral margin of the right anterior clinoid. The case was studied by CT, MRI, MR angiography and digital subtraction angiography
Nasopharingeal Craniopharyngioma with Intracranial Extension
Authors: Patankar T. , Prasad S. , Deshmukh H. , Marfatia H.
Published: April 2015

Primary nasopharingeal craniopharyngioma is extremely rare, although nasopharyngeal extension of primary intracranial craniopharyngioma occurs uncommonly. Only fifteen cases of primary nasopharingeal craniopharyngioma have been reported to date. We describe CT scan findings in a case of a large histologically proven nasopharyngeal craniopharyngioma with contiguous extension into the suprasellar cistern. The patient has been asymptomatic for the past one year following complete tumour excision.
MRI Helps in the Early Diagnosis of Corticobasilar Degeneration
Authors: Gallucci M. , Bonamini M. , Catalucci A. , Leuzzi V. , Micheli C. , Caulo M. , Scarnati E.
Published: April 2015

We describe MR findings in patients with a clinical diagnosis of corticobasal degeneration (CBD). Five patients with different extrapyramidal symptoms were submitted to MRI. All patients were clinically followed-up for a minimum period of at least 12 months. MRI study was performed on a 0.5 T system (Philips NT 5 II), using conventional SE, TSE and t-FLAIR sequences on axial and coronal planes. In all cases MR showed bilateral parietal cortical atrophy. t-FLAIR sequences demonstrated cortical signal alteration on both parietal and frontal cortex in four cases and on the parietal cortex alone in 1 case. During the follow-up clinical evolution gave rise to the suspicion of CBD. MRI demonstrated parietal cortex atrophy even in those cases in which symptoms at onset were not specific for CBD, thus helping the diagnosis. Moreover MRI, using t-FLAIR sequences suggested CBD diagnosis even in the earlier phases of the disease, in which cortical damage has not yet become evident as atrophy.
Echo-Planar MR Sequences in the Diagnosis of Intracranial Infectious Diseases
Authors: Tsuchiya K. , Yoshino A. , Katase S. , Hachiya J.
Published: April 2015

To assess the value of echo-planar-imaging (EPI) MR sequences in the diagnosis of intracranial infectious diseases, we reviewed single-shot EPI MR images obtained in 20 patients comparing them with conventional spin-echo (SE) or fluid attenuated inversion-recovery (FLAIR) images. Their diagnosis included meningitis, encephalitis or meningoencephalitis, brain abscess, epidural empyema, and Creutzfeldt-Jakob disease. We obtained EPI-T2-weighted images (T1WIs) in eight patients, EPI-FLAIR images in 13, and EPI-diffusion-weighted images (DWIs) in 17. Mainly due to the patient's motion, EPI-T2WIs were better than SE-T2WIs in three of the eight patients and EPI-FLAIR images were better than conventional FLAIR images in three of the 13 patients. In the remaining patients, EPI-T2WIs and EPI-FLAIR images were equivalent or inferior to conventional images. In six patients with encephalitis or meningoencephalitis, their lesions of encephalitis showed apparent hyperintensity on EPI-DWIs. In four patients, EPI-DWIs also demonstrated hyperintensity of the contents of abscess or empyema most conspicuously among images obtained. The value of EPI-T2WIs and EPI-FLAIR images is considered to be limited in uncooperative patients. However, EPI-DWIs could provide valuable information in some diseases.
MR Evaluation of Dural Venous Sinus Invasion by Intracranial Meningiomas a Combined MRI-MRA Approach
Authors: Patay Z. , Brotchi J. , Al-Watban J. , David Ph. , Balériaux D.
Published: April 2015

We established a standard, reproducible MRI-MRA imaging protocol for intracranial meningiomas and tested its feasibility and value in clinical settings. We then create a new, simplified classification, which is based only on criteria which are detectable by MRI and MRA.
Clinical and Radiological Patterns of Human Stroke as Defined by Echo-Planar Diffusion-Weighted MR Imaging
Authors: Lövblad K.O. , Weber J. , Heid O. , Mattle H.P. , Schroth G.
Published: April 2015

We sought to establish the validity of echo-planar diffusion-weighted imaging (DWI) in acute stroke using anisotropic and isotropic imaging. 32 patients with a clinical suspicion of stroke were examined by echo-planar DWI on a 1.5 T magnet. The earliest imaging was performed 90 minutes after onset of symptoms, up to 47 hours. In 30 cases an area of hyperintensity was detected in the brain with a corresponding drop in the rADC.

The ADC drop varied between 10 and 55% when compared to non-ischemic tissue. In two cases where no lesion was detected, symptoms did disappeared and TIAs were diagnosed. Diffusion-weighted imaging of the brain is feasible in patients with acute stroke and appears to be sensitive to the acute cerebral changes encountered in ischemia. I should therefore be possible to use it to select patients for further intervention.
Correlazioni fra reperti spettroscopici e tomografici in tre neonati affetti da encefalopatia ipossico-ischemica con selettivo coinvolgimento dei nuclei alla base
Authors: Cappellini M. , Robertson N. , Cox J. , Kuint J. , Fonda C. , Bydder G.
Published: April 2015

Abbiamo studiato con spettroscopia a risonanza magnetica tre neonati a termine affetti da encefalopatia perinatale ipossico-ischemica con più selettivo interessamento dei nuclei della base e buona prognosi a 6 mesi. Abbiamo verificato la presenza di un valore molto basso del rapporto NAA/Cr ed un elevato valore del rapporto mI/Cr a livello dei nuclei della base, mentre a carico della sostanza bianca questi valori sono risultati quasi normali. I dati sono concordi con quelli riportati in letteratura, ovvero l'abbassamento del rapporto NAA/Cr sarebbe da correlare alla perdita neuronale susseguente al danno ipossico-ischemico, corrispondente alla sede ove tale danno è evidente all'esame di risonanza magnetica, mentre l'innalzamento del rapporto mI/Cr è probabilmente spiegabile con la gliosi reattiva al danno ipossico-ischemico stesso.
CTA and DSA Evaluation of Patients with Subarachnoid Haemorrhage
Authors: Muto M. , Bonsignore R. , Ambrosanio G. , Esposito G. , Cesaro L. , Di Furia U. , Palmieri A.
Published: April 2015

We correlate digital subtraction angiography (DSA) and computed tomography with angiographic 3D reconstruction (CTA) in patients with subarachnoid haemorrhage. 45 patients were evaluated with both techniques (CTA and DSA) within 3–4 days after acute haemorrhage: source CT images, MIP and 4D-angio reconstruction and standard DSA were performed and correlated. The MIP tecnique is very easy and quick to perform and operator independent, while 4D-angio reconstruction requires at least 30 minutes to obtain good quality images.

CTA and DSA were equivalent in demonstrating the presence of all 57 aneurysms in the 45 patients. Most aneurysms were located at the level of the circle of Willis; CTA was not adequate to demonstrate the neck of aneurysms in 7 cases located in of the syphon, vertebral artery and posterior communicating artery; CTA gave a good display of the thrombus within the aneurysm.

Patients could go directly from the CT diagnostic room to the operating room in certain types of aneurysm such as those in the anterior communicating artery or middle cerebral artery in which there is a correlation between site of the haemorrhage and the aneurysm. In the future, improvements in MR technology will also exclude aneurysms in sites difficult to evaluate by CTA such as the syphon, so that DSA will be performed only in selected doubtful cases.
Controllo neuroradiologico precoce su una casistica di 132 tumori encefalici operati
Authors: Bacci A. , Barbara C. , Simonetti L. , Bartolini S. , Belveder C. , Leonardi M.
Published: April 2015

Vengono riportati i risultati di uno studio su un campione costituito da 132 tumori intracerebrali primitivi operati dal 1 gennaio 1996 al 31 dicembre 1996 presso la Divisione di Neurochirurgia dell'Ospedale Bellaria di Bologna. I tumori erano per la maggior parte gliomi ad alto grado di malignità, poi gliomi a basso grado, gangliocitomi, ependimomi, medulloblastomi.

In tutti i casi è stato eseguito un esame neuroradiologico postoperatorio precoce TC o RM prima e dopo somministrazione di mdc. In accordo con i dati riportati in letteratura il controllo postoperatorio è stato effettuato entro il terzo o quarto giorno dall'intervento, affinchè le modificazioni parenchimali conseguenti all'atto chirurgico non rendessero difficoltosa o impossibile la rilevazione della presenza o assenza di residuo neoplastico.

È stato scelto di fare lo studio TC nei tumori maligni e lo studio RM nei gliomi a basso grado di malignità o tumori della fossa cranica posteriore.

Nei 98 casi in cui la rimozione chirurgica era stata parziale o subtotale anche gli esami neuroradiologici mostravano la presenza di residuo neoplastico. Dei 34 casi in cui il giudizio neurochirurgico era stato di asportazione totale della neoplasia, in 14 era possibile stabilire la presenza di residuo tumorale certo, in 4 dubbio, in 9 non-residuo e in 7, per la presenza di ematoma nel cratere, non era possibile fare una valutazione certa.

La necessità di documentare la presenza o meno di residuo neoplastico dopo l'intervento chirurgico nasce da esigenze prognostiche e di pianificazione terapeutica.

È stato documentato che la prognosi peggiora drammaticamente in presenza di residuo. Infatti il 75% dei pazienti con glioma maligno, se ha residuo nel controllo postoperatorio, presenta la ripresa della malattia entro 6 mesi, cosa che si verifica solo nel 36% dei pazienti senza residuo.

Nella pianificazione della terapia postchirurgica: radioterapia o chemioterapia, la presenza o meno di residuo neoplastico è di fondamentale importanza. Nei tumori maligni in presenza di residuo si può ipotizzare, dopo la radioterapia convenzionale, l'esecuzione di “Boost” focalizzato con radiochirurgia o brachiterapia. Inoltre attualmente si tende ad effettuare chemioterapia solo in caso di presenza di residuo tumorale postoperatorio.

Nei tumori a basso grado di malignità la radicalità della chirurgia riveste ancora maggiore importanza. Infatti nei pazienti giovani, al di sotto dei 30 anni di età, se il tumore è stato asportato completamente la radioterapia può essere rimandata fino al momento dell'eventuale ripresa di malattia.
Tuber Cinereum Hamartomas and Gelastic Epilepsy
Authors: Cirillo S. , Caranci F. , Briganti F. , D'Amico A. , Striano S. , Elefante R.
Published: April 2015

We studied five patients with gelastic epilepsy sustained by hamartoma of the tuber cinereum, submitted to EEG and Video-EEG study and to MR examination. The mechanism of ictal laughter, clinical associations and prognosis for seizure control are discussed.

Hamartomas should be always suspected when gelastic seizures occur, and appropriate diagnostic tools should be employed for their diagnosis. In patients presenting with gelastic epilepsy, MR assessment of the hypothalamic region is necessary to identify a hamartoma of the tuber cinereum.

Moreover, the resolution of MR imaging provides a basis to correlate some of the clinical manifestations with the anatomical disposition of the lesion within the hypothalamus.

Gelastic epilepsy seems to correlate with large broad-based hamartomas in relationship with the mamillary bodies. In these cases, surgical treatment should be considered when symptoms are not sufficiently responsive to medical therapy.
Pathogenesis of Chiari Malformation: A Morphometric Study of the Posterior Cranial Fossa
Authors: Nishikawa M. , Sakamoto H. , Hakuba A. , Nakanishi N. , Inoue Y.
Published: April 2015

To investigate overcrowding in the posterior cranial fossa as the pathogenesis of adult type Chiari malformation, we morphometrically studied the brainstem and cerebellum within the posterior cranial fossa as well as the occipital bone while taking into consideration their embryological development.

Compared with the control group, the Chiari group had a significantly larger “volume ratio” as PFBV/PFCV, the three occipital enchondral parts (the basiocciput, exocciput and supraocciput) were significantly smaller and the tentorium was much steeper. There was no significant difference in the posterior fossa brain volume or in the axial lengths of the hindbrain (the brainstem and cerebellum). These results suggest that in adult type Chiari malformation an underdeveloped occipital bone, possibly due to underdevelopment of the occipital somite originating from the paraxial mesoderm, induces overcrowding in the posterior cranial fossa which contains the normally developed hindbrain, and secondary the cerebellar tonsils herniate into the spinal canal.