bluuebunny/crossref_metadata_2025 huggingface dataset:
Brain Fat Embolism
Authors: Decaminada N. , Thaler M. , Holler R. , Salsa A. , Ladiges C. , Rammlmair G.
Published: April 2015

Fat embolism syndrome [FES] is an uncommon but serious complication of traumatic injures, which can follow a wide range of other surgical and medical conditions and can manifest with a collection of respiratory, hematological, neurological and cutaneous symptoms. FES should be suspected in all cases of traumatic injures with altered mental status following a period of normal neurological function, especially after orthopedic fixation of long bone fractures. Neurological symptoms must not be related to the initial trauma. The objective of this study was to describe the characteristics of FES and to correlate the neuroradiological findings with the clinical symptoms and the outcome of two cases of cerebral FES which occurred in two young men after bone fractures of the extremities without cranial traumatism. Both patients were studied by brain computed tomography (CT) and by brain magnetic resonance (MR). While Cerebral CT was inadequate to the diagnosis, Cerebral MR, performed 48 hours after injury, showed several focal areas of pathological signal in the white matter of the subcortical, periventricular and centrum semiovale regions, as well as in the basal ganglia and cerebellum. The neuroradiological findings of the two patients were compared with their clinical symptoms and outcome. The patient with the worst prognosis showed more lesions on MR and a restricted diffusion on DWI-MR, due to cytotoxic edema, whereas the patient with the better outcome showed lesions due to vasogenetic edema without any restricted diffusion. Cerebral MR and DW-MR are sensitive indicators for the early diagnosis of FES and can give a vast amount of information on the prognosis and future outcome.
A Brain Parenchyma Model-Based Segmentation of Intraventricular and Intracerebral Haemorrhage in CT Scans
Authors: Prakash K.N. Bhanu , Morgan T.C. , Hanley D.M. , Nowinski W.L.
Published: April 2015

Accurate quantification of haemorrhage volume in a computed tomography (CT) scan is critical in the management and treatment planning of intraventricular (IVH) and intracerebral haemorrhage (ICH). Manual and semi-automatic methods are laborious and time-consuming limiting their applicability to small data sets. In clinical trials measurements are done at different locations and on a large number of data; an accurate, consistent and automatic method is preferred. A fast and efficient method based on texture energy for identification and segmentation of hemorrhagic regions in the CT scans is proposed. The data set for the study was obtained from CLEAR-IVH clinical trial phase III (41 patients’ 201 sequential CT scans from ten different hospitals, slice thickness 2.5–10 mm and from different scanners). The DICOM data were windowed, skull stripped, convolved with textural energy masks and segmented using a hybrid method (a combination of thresholding and fuzzy c-means). Artifacts were removed by statistical analysis and morphological processing. Segmentation results were compared with the ground truth. Descriptive statistics, Dice statistical index (DSI), Bland-Altman and mean difference analysis were carried out. The median sensitivity, specificity and DSI for slice identification and haemorrhage segmentation were 86.25%, 100%, 0.9254 and 84.90%, 99.94%, 0.8710, respectively. The algorithm takes about one minute to process a scan in MATLAB®. A hybrid method-based volumetry of haemorrhage in CT is reliable, observer independent, efficient, reduces the time and labour. It also generates quantitative data that is important for precise therapeutic decision-making.
Optimization of Pulse Sequences for Lactate Detection and its Diagnostic Value in Acute Cerebral Infarction Using 1H MR Spectroscopy
Authors: Rao H-B. , Guo Y-L. , Wu R-H.
Published: April 2015

Cerebral infarction will cause ischemic encephalopathy and lactate accumulation in the brain in acute cerebral infarction. This study investigated the optimization of pulse sequences for lactate detection and its diagnostic value in acute cerebral infarction using proton MR spectroscopy (1H MRS). The studies were performed on a phantom and on 17 patients with acute cerebral infarction. Examinations were performed with a GE 1.5T MRI system (Signa). The spectra were obtained using both PRESS and STEAM sequences. The spectra were processed using a GE Advantage workstation (ADW 4.3). Moreover, the optimal sequence combined with other sequences, including conventional MRI sequences and MR DWI, were used to acquire proton MRI data for 17 patients with acute cerebral infarction and 20 healthy volunteers. The maximum lactate peaks using TE=135 ms were down doublet whereas the peaks using 270 ms were up doublet. Lactate peaks were ascending in 17 patients with cerebral infarction. Optimized 1H MRS sequences are useful for better detection of lactate in acute cerebral infarction.
Anaplastic Ganglioglioma of the Brainstem in an Adult
Authors: Toledo E. González , Nader M. , Thomas-Ogunniyi J. , Wilson J.
Published: April 2015

Gangliogliomas are neoplasms with neuronal and glial components. The most common location is the temporal lobe and for that reason those patients have seizures as the major complaint. Gangliogliomas with anaplastic features are uncommon. A 33-year-old man presented with a two-year history of progressively worsening right-sided weakness and contractures. Physical examination demonstrated right-sided weakness and contractures involving the upper and lower extremities. Magnetic resonance demonstrated multiple nodules involving the tegmental pons with a small projection into the prepontine cistern on the left, midbrain tegmentum on the left in the subthalamic region. The patient was studied by MRI on T1WI, T2WI, FLAIR, DWI, and magnetic resonance spectroscopy. He underwent a craniotomy and biopsy of the mass. Histological examination of the specimen revealed glial proliferation. Based on these findings the pathologic diagnosis was anaplastic ganglioglioma. Only one previous report of an anaplastic astrocytoma in the cerebello-pontine angle in an adult has been published. In children three cases were reported, only one with magnetic resonance. Our case showed multiple nodular structures hypointense on T1 and hyperintense on T2 and FLAIR with enhancement on T1 after injection of paramagnetic contrast. Only in this contribution T2 value were diffusion-weighted and ADC characteristics and 1H spectroscopy analyzed.
Association of Pulsatility Index in the Middle Cerebral Artery with Intelligence Quotient in Children with Sickle Cell Disease
Authors: Krejza J. , Arkuszewski M. , Radcliffe J. , Flynn T.B. , Chen R. , Kwiatkowski J.L. , Ichord R. , Zimmerman R. , Bilello M. , Ohene-Frempong K. , Melhem E.R.
Published: April 2015

The aim of this study was to explore whether intellectual performance in children with Sickle Cell Disease and with low risk of stroke as determined with conventional transcranial Doppler ultrasonography (TCD) criteria was associated with hemodynamic parameters in imaging TCD, when controlling for hematological and socio-economical variables and presence of silent infarcts. We performed neuropsychological testing with Kaufman Brief Intelligence Test (K-BIT-IQ) and imaging TCD examinations to measure blood flow velocities and pulsatility indexes (PI) in the middle cerebral arteries (MCA) In 46 children with homozygous HbSS (mean age 108±34 months, range limits: 47–166 months; 24 females), without a history of stroke or transient ischemic attack, with no stenosis on magnetic resonance angiography and with velocities below 170 cm/s in screening conventional TCD. Mean K-BIT IQ Composite and Vocabulary scores (91±13 and 86±14 respectively) were significantly below the average scores of 100 for the age-matched population (one sample t-test=5.21, p<0.001). Using univariate and multivariate regression models, we found that lower PI in the right MCA was associated with lower K-BIT-IQ Composite and Vocabulary scores. Furthermore, we found that interhemispheric differences in PIs were even more strongly associated with neuropsychological performance, whereas flow velocities were not associated with the K-BIT-IQ score. Using a model of chronic anemia, we found that cognitive functioning was associated with cerebral hemodynamics.
An Atypical Case of Chiari II Malformation Mimicking Partial Rhombencephalosynapsis
Authors: Guleria S. , Kelly T.G. , Maheshwari M. , Segall H.D.
Published: April 2015

Partial rhombencephalosynapsis in the presence of Chiari II malformation has been proposed as a “new abnormality of the hindbrain and spine“. We describe a case of Chiari II malformation with imaging features mimicking partial rhombencephalosynapsis. Our case demonstrates how the imaging findings of Chiari II malformation can be confused with the above entity and highlights the differentiating features to help radiologists make an accurate diagnosis.
Spontaneous Migration of a Redundant Nerve Root Accompanied by Absorption of Lumbar Disk Herniation
Authors: Koda M. , Rokkaku T. , Mannoji C. , Okamoto Y. , Kon T. , Murakami M. , Furuya T. , Yamazaki M.
Published: April 2015

A redundant nerve root is defined as a large, elongated and tortuous nerve root commonly associated with severe lumbar spinal canal stenosis. Elongation of nerve roots as a result of mechanical trapping at stenotic level is assumed to be a possible mechanism. Here we present a case in a patient who showed a redundant nerve root above the level of a lumbar canal stenosis caused by disk herniation and redundancy spontaneously migrating to a lower lumbar stenosis level accompanied by absorption of the herniated disk as shown by magnetic resonance imaging (MRI). A 67-year-old Japanese woman presented with bilateral thigh/leg pain and intermittent claudication. A midsagittal T2-weighted MR image of the lumbar spine revealed severe spinal canal stenosis at the L3–4 and L4–5 levels. At the L3–4 level, central disk herniation compressed the dural tube. An MR image revealed redundant nerve roots just cranial to the severely compressed L3–4 level. A follow-up MRI study revealed regression of disk herniation at the L3–4 level. In contrast, there was no significant change of the stenosis at the L4–5 level. Sagittal T2-weighted MR imaging at follow-up revealed redundant nerve roots just cranial to the L4–5 level, whereas the redundant nerve roots cranial to the L3–4 level had disappeared. The MRI findings of the present case support the “squeeze” hypothesis as causative of redundant nerve roots.
Cortical Laminar Necrosis and CT Negative Hemorrhage in Posterior Reversible Encephalopathy Syndrome
Authors: Ahmad I. , Kralik S. , Ho C.Y. , Ammar T. , Douglas A.C.
Published: April 2015

Posterior reversible encephalopathy syndrome (PRES) is a clinicoradiologic condition that typically demonstrates symmetric occipitoparietal vasogenic edema on CT and MR imaging. The vasogenic edema typically resolves over a period of days to weeks if the underlying hemodynamic abnormality is promptly corrected. Less commonly, PRES may be complicated by hemorrhage or cytotoxic edema that restricts diffusion and usually involves the cerebral cortex. Cortical laminar necrosis (CLN) is a sequela of cerebral energy depletion, resulting in selective necrosis of the most metabolically active cortical layers. Cortical hemorrhage is an atypical feature of CLN. We present a unique PRES case with imaging features of both CLN and CT negative hemorrhage. CLN with CT negative hemorrhage in the setting of PRES has not been previously reported to the best of our knowledge.
A Rare Case of Intraosseous Lipoma Involving the Sphenoclival Region
Authors: Caranci F. , Cirillo M. , Piccolo D. , Briganti G. , Cicala D. , Leone G. , Briganti F.
Published: April 2015

We describe the case of a 23-year-old man whose CT scan revealed a hypodense lesion reshaping the superior and middle third of the clivus and partially invading the sphenoidal sinus. MRI showed an irregular-shaped lesion occupying the body of the sphenoid bone, involving the superior and middle third of the clivus and sprouting into the sphenoid sinus. The lesion was hyperintense on T1- and T2-weighted sequences with a thin peripheral rim of hypointensity, without enhancement after i.v. gadolinium injection. The pathology report confirmed an intraosseus lipoma. Intraosseous lipomas involving the spheno-clival region are extremely rare. CT and MRI scan interpretation can be troublesome but this rare pathology has to be considered in the differential diagnosis.
Endovascular Treatment of a Giant Dissecting Aneurysm of the Posterior Cerebral Artery
Authors: Briganti F. , Cicala D. , Tortora F. , Leone G. , Napoli M. , Maiuri F.
Published: April 2015

We describe the case of a 60-year-old man who presented with a giant dissecting aneurysm of the left P2 segment. Intracranial dissecting aneurysms often occur in the vertebrobasilar system, but rarely involve the posterior cerebral artery (PCA). PCA aneurysms tend to have some peculiar features and therefore may be considered a separate entity, even from the vertebrobasilar aneurysms. The patient was treated by endovascular occlusion of both parent vessel and the aneurysm, and he tolerated the procedure well with a complete resolution of clinical deficit, following volume reduction of the aneurysm. This paper presents additional evidence to literature reports suggesting that endovascular parent artery occlusion with coils is an effective and well-tolerated treatment for distal PCA aneurysms. Our review contributes to collect data regarding the incidence of recurrence as a measure of long-term efficacy of this therapeutic approach.
Pediatric Inflammatory Diseases
Authors: Gallucci M. , Smith J.D. , Limbucci N. , Rossi A. , Demaerel P. , Krings T. , Damico A. , Micheli C.
Published: April 2015

Some rare neurological diseases affecting children have no well defined etiology and pathogenetic mechanisms. In this article diseases like Reye syndrome, Behçet disease, pediatric neurosarcoidosis, Posterior Reversible Encephalopathy Syndrome are described. Some of the main neuroradiological differential aspects are also critically considered. Reye syndrome is characterized by symmetric thalamic, white matter and basal ganglia lesions, in children with recent history of salycilates or immunosuppressive drugs intake. The most typical MRI feature of neurosarcoidosis is basilar meningeal thickening and enhancement with intraparenchymal enhancing nodules and white matter focal abnormalities. The classical distribution of lesions helps differential diagnosis with infectious meningoencephalitis. Differential diagnosis with relapsing-remitting multiple sclerosis his helped by the evidence of meningeal abnormalities. Neuro-Behçet is characterized by mesodiencephalic lesions in children with encephalopathy and coexistence of oral and genital ulcers and ocular abnormalities. PRES can be differentiated from vasculitis for the typical posterior white matter involvement and the different clinical features.
Burkitt Lymphoma as a Cause of Carotidynia: Imaging Features
Authors: Pina S. , Battal B. , Castillo M.
Published: April 2015

We describe a patient with Burkitt lymphoma who developed carotidynia. MRI showed thickening of the walls of both common carotid arteries and PET CT showed increased radiotracer uptake in the same regions. MRI was essential in establishing the diagnosis of this rare clinical presentation.
Coiling Occlusion of the Vertebral Artery for a Patient with Recurrent Posterior Circulation TIAs
Authors: Chembala J. , Jadun C. , Natarajan I. , Roffe C.
Published: April 2015

Recurrent posterior circulation infarcts frequently involve multiple vascular territories, suggesting an embolic source. We describe a patient with left vertebral artery occlusion who had recurrent transient ischaemic attacks due to cerebral embolization originating from the occluded vertebral artery in spite of optimal anticoagulant and antithrombotic treatment. This was successfully managed by coiling occlusion of the vertebral artery with no recurrence of symptoms over one year of follow-up. To our knowledge, this is the first report of coiling occlusion in the treatment of recurrent vertebral artery embolization.
Lymphoblastic Leukaemia Presenting as a Carotid-Cavernous Fistula
Authors: Bagga V. , Yapa S. , Craven I. , Romanowski C. , Jellinek D.
Published: April 2015

A carotid-cavernous fistula is a life-threatening condition characterised by an abnormal communication between the carotid arterial vessels and the cavernous venous system. Although these fistulae can arise spontaneously, they mainly occur after trauma, especially road traffic accidents, falls and penetrating cranial or orbital injuries. The mainstay of treatment involves endovascular embolization, but in those patients where this is not possible or where embolization fails, direct surgical intervention and ligation of the artery may be necessary. Here we describe an interesting case of a suspected carotid-cavernous fistula which turned out to be cavernous sinus syndrome secondary to lymphoma.
Progressive Spinal Cord Compression Due to Epidural Extramedullary Hematopoiesis in Thalassemia Intermedia
Authors: Ghieda U. , Elshimy M. , El Beltagi A. H.
Published: April 2015

Extramedullary hematopoiesis (EMH) can occur in patients with thalassemia intermedia as a physiologic response to insufficient erythropoiesis to meet circulatory demands. Rarely, EMH involve the epidural space causing spinal cord compression. We describe a case of EMH in a 21-year-old man with β-thalassemia intermedia presenting with progressive low back pain, worsening paraparesis and sphincter disturbance. Magnetic resonance imaging (MRI) demonstrated spinal cord compression by EMH epidural mass lesions extending from T3 to T10 levels. An emergency multilevel decompressive laminectomy was performed with excision of the masses and complete rehabilitation of the patient.
Nosocomial Herpes Encephalitis: Rare but Treatable with Early MR Diagnosis
Authors: Doshi P. , Post M.J. Donovan , Saigal G. , Podda A. , Quencer R.
Published: April 2015

Nosocomial/hospital acquired herpes encephalitis is rare and is usually undiagnosed in its early phase because of the non-specific clinical picture and low level of clinical and neuroimaging suspicion. There is a paucity of data in radiology literature for this entity, specifically in the settings of surgery and trauma. We describe two cases of nosocomial herpes simplex encephalitis to demonstrate the imaging clues that might lead to an early diagnosis of this disease.
A Bayesian Diagnostic System to Differentiate Glioblastomas from Solitary Brain Metastases
Authors: Chen R. , Wang S. , Poptani H. , Melhem E.R. , Herskovits E.H.
Published: April 2015

This paper aimed to construct a Bayesian network-based decision support system to differentiate glioblastomas from solitary metastases, based on multimodality MR examination. We enrolled 51 patients with solitary brain tumors (26 with glioblastomas and 25 with solitary brain metastases). These patients underwent contrast-enhanced T1-weighted magnetic resonance (MR) examination, diffusion tensor imaging (DTI), dynamic susceptibility contrast (DSC) MRI, and fluid-attenuated inversion recovery (FLAIR). We generated a set of MR biomarkers, including relative cerebral blood volume in the enhancing region, and fractional anisotropy measured in the immediate peritumoral area. We then generated a Bayesian network model to represent associations among these imaging-derived predictors, and the group membership variable, (glioblastoma or solitary metastasis). This Bayesian network can be used to classify new patients' tumors based on their MR appearance. The Bayesian network model accurately differentiated glioblastomas from solitary metastases. Prediction accuracy was 0.94 (sensitivity = 0.96, specificity = 0.92) based on leave-one-out cross-validation. The area under the receiver operating characteristic curve was 0.90. A Bayesian network-based decision support system accurately differentiates glioblastomas from solitary metastases, based on MR-derived biomarkers.
Brain Microbleeds: Distribution and Influence on Hematoma and Perihematomal Edema in Patients with Primary Intracerebral Hemorrhage
Authors: Lin Wei-Ming , Yang Tse-Yen , Weng Hsu-Huei , Chen Chih-Feng , Lee Ming-Hsueh , Yang Jen-Tsung , Jao Shaner Yeun Ng , Tsai Yuan-Hsiung
Published: April 2015

Brain microbleed is a marker of small vessel microhemorrhagic or microaneurysmal lesions, which may induce intracerebral hemorrhage (ICH). This study to prospectively evaluated the association between microbleeds, hematoma and perihematomal edema volume, and various clinical data, as well as patient outcome. Thirty-one patients with ICH and 31 healthy age-matched subjects were enrolled in our study. They were divided into two groups according to the presence or absence of microbleeds detected by MRI. Serial clinical and laboratory data were recorded. Modified Rankin Scale and Barthel Index were estimated three months after hemorrhage. The major location of microbleeds among patients with ICH was the basal ganglia. The volume of perihematomal edema was correlated with the initial hematoma volume on the first, fifth and seventh days after hemorrhage in patients with microbleeds. For patients without microbleeds, this correlation was also significant on the seventh day. Cerebral microbleeds in patients with ICH, especially in the basal ganglia region, represent micro-angiopathy, and are associated with leakage of blood and formation of perihemorrhage edema. Brain microbleeds found in patients with ICH warrant further investigation for evaluation of stroke risk.
Sickle Cell Anemia: Reference Values of Cerebral Blood Flow Determined by Continuous Arterial Spin Labeling MRI
Authors: Arkuszewski M. , Krejza J. , Chen R. , Melhem E.R.
Published: April 2015

Sickle cell anemia (SCA) is a chronic illness associated with progressive deterioration in patients' quality of life. The major complications of SCA are cerebrovascular accidents (CVA) such as asymptomatic cerebral infarct or overt stroke. The risk of CVA may be related to chronic disturbances in cerebral blood flow (CBF), but the thresholds of “normal” steady-state CBF are not well established. The reference tolerance limits of CBF can be useful to estimate the risk of CVA in asymptomatic children with SCA, who are negative for hyperemia or evidence of arterial narrowing. Continuous arterial spin labeling (CASL) MR perfusion allows for non-invasive quantification of global and regional CBF. To establish such reference tolerance limits we performed CASL MR examinations on a 3-Tesla MR scanner in a carefully selected cohort of 42 children with SCA (mean age, 8.1±3.3 years; range limits, 2.3–14.4 years; 24 females), who were not on chronic transfusion therapy, had no history of overt stroke or transient ischemic attack, were free of signs and symptoms of focal vascular territory ischemic brain injury, did not have intracranial arterial narrowing on MR angiography and were at low risk for stroke as determined by transcranial Doppler ultrasonography.
Developmental Venous Anomaly Responsible for Hemifacial Spasm
Authors: Chiaramonte R. , Bonfiglio M. , D'Amore A. , Chiaramonte I.
Published: April 2015

Hemifacial spasm (HFS) is a facial movement disorder characterized by involuntary, unilateral and intermittent contractions of the facial muscles. It is one of the syndromes related to neurovascular conflict, first described by Jannetta et al. in 1979. Typically, HFS is due to pulsatile compression by the anterior inferior cerebellar artery. We describe a rare case of left developmental venous anomaly in a 59-year-old man referred to us with a six-month history of left-sided HFS. We performed an MR study of the brain and cerebellopontine angles, which demonstrated a compression of the ipsilateral facial nerve by the developmental venous anomaly.
Proton Magnetic Resonance Spectroscopy (H-MRS) in Chronic Schizophrenia. A Single-Voxel Study in Three Regions Involved in a Pathogenetic Theory
Authors: Granata F. , Pandolfo G. , Vinci S. , Alafaci C. , Settineri N. , Morabito R. , Pitrone A. , Longo M.
Published: April 2015

The cognitive dysmetria theory suggests a disconnectivity between the dorsolateral prefrontal cortex, thalami and vermis to explain the pathophysiology of schizophrenia. This study investigated the metabolic integrity of this neurologic circuit in patients with schizophrenia using proton magnetic resonance spectroscopy (H-MRS). Twenty-two patients with schizophrenia and twelve control subjects were studied. Metabolites concentrations were evaluated by a single-voxel technique in the prefrontal cortex, thalami and vermis. To our knowledge, this is the first H-MRS experience with concomitant evaluation of these regions in schizophrenic patients. We found no significant statistical difference in N-AA, Cho and Cr absolute concentrations and N-AA/Cho, N-AA/Cr and Cho/Cr ratios between the schizophrenic patients and control group. At the vermis, we found a constant spectrum with low levels of N-AA and higher levels of Cho and Cr. Our experience does not clearly support or refute the cognitive dysmetria theory. The consistency of metabolic findings in the cerebellar vermis could represent an important datum, highlighting the specificity of metabolic and functional activity in this region.
Accuracy of Transcranial Ultrasound in the Detection of Mild White Matter Lesions in Newborns
Authors: Ciambra G. , Arachi S. , Protano C. , Cellitti R. , Caoci S. , Di Biasi C. , Gualdi G. , De Curtis M.
Published: April 2015

Cranial Ultrasound (cUS) may not be sensitive enough to detect subtle white matter (WM) injuries. Our study compared serial cUS with MRI at term equivalent age (TEA) to determine if it is possible to identify an ultrasound representation of subtle diffuse WM injuries such as punctate lesions (PWMLs) and diffuse excessive high signal intensity (DEHSI). Fifty-six very preterm infants were scanned sequentially from birth to TEA, an MRI was performed at TEA. Each echodensity found on cUS was classified as absent, transient (≤7 days), or prolonged (>7 days). A transient periventricular echodensity was detected in seven infants (12.5%), and a prolonged echodensity in 15 (26.8%). MRI examinations were performed in all 56 infants. No altered signal intensity was found in 18 infants (32.1%). DEHSI was detected in 14 infants (25%), and PWMLs were detected in eight babies (14.3%). Both abnormalities were found in 16 infants (28.6%). The positive predictive values of the prolonged echodensity for DEHSI and PWMLs were 86.7% and 46.7% respectively. However, a significant statistical correspondence (p=0.002, Odds Ratio 11.9) was found comparing DEHSI with cUS abnormal echodensities. Serial cUS during the neonatal period in preterm infants is essential and cannot be replaced with MRI at TEA. MRI seems to be more reliable in detecting mild or moderate WM abnormalities. However, serial cUS performed by an experienced neonatologist can provide valuable information on early WM changes such as prolonged echodensities that could potentially lead to a diffuse injury.
Unusual Case of Cerebral Aspergillosis with Clinical and Imaging Findings Mimicking Lymphoma
Authors: Sidani C. , Freiser M.E. , Saigal G. , Sklar E.
Published: April 2015

A 14-year-old female post-transplant patient with a history of post-transplant lymphoproliferative disease/lymphoma presented with fever and lethargy. Computed tomography of the brain demonstrated a hypodense lesion with surrounding edema in the right periventricular region not seen on a routine study performed two weeks earlier. On magnetic resonance imaging (MRI) this lesion was mainly iso-intense to gray matter on T2-weighted (T2W) images and demonstrated peripheral contrast enhancement. Diffusion restriction was seen within most of the lesion including, but not limited to, its periphery. Lesion location and MRI characteristics, particularly on T2W and diffusion sequences, were suggestive of lymphoma. The patient's history of post-transplant lymphoproliferative disorder also supported this diagnosis. However, in view of the patient's immunocompromised state, rapid onset of symptoms, and recent normal CT scan of the brain, infection was also entertained. Biopsy revealed short branching hyphae consistent with aspergillosis. This case is interesting as the MRI restriction pattern and the patient's history were more suggestive of lymphoma, but in reality the lesion represented an evolving aspergillosis abscess. Biopsy was necessary to further proceed with appropriate medical management, which is significantly different for the two entities.
MR Assessment of Lumbar Disk Herniation Treated with Oxygen-Ozone Diskolysis: The Role of DWI and Related ADC versus Intervertebral Disk Volumetric Analysis for Detecting Treatment Response
Authors: Splendiani A. , Perri M. , Conchiglia A. , Fasano F. , Di Egidio G. , Masciocchi C. , Gallucci M.
Published: April 2015

We prospectively assessed the diagnostic criteria of morphologic MRI study (MMS) and the accuracy of DWI and related ADC values (DWI-ADC) versus intervertebral disk volumetric analysis (IDVA) for predicting shrinkage of lumbar disk herniation treated with oxygen-ozone (O2-O3) diskolysis. Sixty-eight patients (36 men and 32 women; mean age 39) with lumbosciatica underwent O2-O3 diskolysis. The six-month MRI follow-up was performed with FSE-T2 and T2-fat, SE-T1 and DWI-weighted images. IDVA was determined using OsiriX®. Diagnostic criteria and accuracy were evaluated with regards to DWI and related ADC in detecting response to ozone therapy. Fifty-eight of 68 patients had successful outcomes (responders), whereas ten patients showed unsatisfactory outcomes (non-responders). MMS showed that a centrally located herniated disk and grade 1 nerve root compression were more common in the responder group (p < 0.05). DWI-ADC and IDVA showed statistically significant shrinkage in the sixth month of follow-up (p < 0.05) with a mean ADC value reduction of 2.10 × 10−3mm2/s +/− 0.19 SD in the second month of follow-up (p < 0.05). DWI-ADC had an accuracy of 0.81 in detecting response to therapy around the second month of follow-up. DWI-ADC appear to be useful adjuncts to MMS in the follow-up of patients undergoing O2-O3 diskolysis.
Semiautomatic Regional Segmentation to Measure Orbital Fat Volumes in Thyroid-Associated Ophthalmopathy
Authors: Comerci M. , Elefante A. , Strianese D. , Senese R. , Bonavolontà P. , Alfano B. , Bonavolontà G. , Brunetti A.
Published: April 2015

This study was designed to validate a novel semi-automated segmentation method to measure regional intra-orbital fat tissue volume in Graves' ophthalmopathy. Twenty-four orbits from 12 patients with Graves' ophthalmopathy, 24 orbits from 12 controls, ten orbits from five MRI study simulations and two orbits from a digital model were used. Following manual region of interest definition of the orbital volumes performed by two operators with different levels of expertise, an automated procedure calculated intra-orbital fat tissue volumes (global and regional, with automated definition of four quadrants). In patients with Graves' disease, clinical activity score and degree of exophthalmos were measured and correlated with intra-orbital fat volumes. Operator performance was evaluated and statistical analysis of the measurements was performed. Accurate intra-orbital fat volume measurements were obtained with coefficients of variation below 5%. The mean operator difference in total fat volume measurements was 0.56%. Patients had significantly higher intra-orbital fat volumes than controls (p<0.001 using Student's t test). Fat volumes and clinical score were significantly correlated (p<0.001). The semi-automated method described here can provide accurate, reproducible intra-orbital fat measurements with low inter-operator variation and good correlation with clinical data.
Correlation between Cerebral Blood Volume Measurements by Perfusion-Weighted Magnetic Resonance Imaging and Two-Year Progression-Free Survival in Gliomas
Authors: Spampinato M.V. , Schiarelli C. , Cianfoni A. , Giglio P. , Welsh C.T. , Bisdas S. , Rumboldt Z.
Published: April 2015

Our goal was to determine whether relative cerebral blood volume (rCBV) can serve as an adjunct to histopathologic grading in the assessment of gliomas, with the hypothesis that rCBV can predict two-year survival. We evaluated 29 newly diagnosed gliomas (13 WHO grade II, seven grade III, nine grade TV; 17 astrocytomas, 12 oligodendroglial tumors). Dynamic susceptibility-weighted contrast-enhanced perfusion MR images and CBV maps were obtained. rCBVmax measurements (maximum tumor CBV/contralateral normal tissue CBV) and progression-free survival (PFS) were recorded. Receiver operating characteristic curves and Kaplan-Meier survival curves were calculated for rCBVmax and histologic grade. rCBVmax measurements differed between gliomas without (2.38 +/− 1.22) and with progression (5.57 +/− 2.84) over two years. The optimal rCBVmax cut-off value to predict progression was 2.95. rCBVmax < 2.95 was a significant predictor of two-year PFS, almost as accurate as WHO grade IT In the pure astrocytoma subgroup, the optimal rCBVmax cut-off value to predict progression was 2.85. In this group rCBVmax < 2.85 was a significant predictor of two-year PFS, an even better predictor of two-year PFS than WHO grade IT rCBVmax can be used to predict two-year PFS in patients with gliomas, independent of pathologic findings, especially in tumors without oligodendroglial components.
Carotid Artery Stenosis near a Bifurcation Investigated by Fluid Dynamic Analyses
Authors: Filardi V.
Published: April 2015

Haemodynamic physical parameters play a role in determining endothelial cell phenotype and influence vascular remodelling. Accurate measurement of total pressure, velocity magnitude, and wall shear stress is vital for studies on the pathogenesis of atherosclerosis. This paper investigated a lesion-based computational fluid dynamic (CFD-Fluent) pilot analysis to understand the complex haemodynamic changes prevailing in patients with high-grade carotid artery stenosis (CS) 90%. All subjects were examined with colour-flow Doppler, power Doppler, and digital subtraction angiography to enable visualization of carotid stenosis and plaque surface morphology, and used to generate computational meshes. Two models were devised: the first without any stenosis and the second with an 82% grade of stenosis localized in the external carotid artery. The distribution of the principal parameters can be obtained by computational fluid dynamics (CFD-Fluent) using patient-specific geometries and flow analytical measurements. The total pressure distribution ranged between 16,000 and 8,000 Pa in the case of normal carotid artery and 16,000 and 5,500 Pa in the case of the stenosed artery. The velocity registered a peak in the stenosis region of 5 m/s. The mean wall shear stress within the stenosis region was 360 Pa. In conclusion, patient-based CFD-Fluent analysis of CS predicts a complex haemodynamic environment with large spatial haemodynamic parameter variations that occur very rapidly over short distances. Our results improve estimates of the flow changes and forces at the vessel wall in CS and the link between haemodynamic changes and stenosis pathophysiology.
Disease Activity in Graves' Ophthalmopathy: Diagnosis with Orbital MR Imaging and Correlation with Clinical Score
Authors: Tortora Fabio , Cirillo Mario , Ferrara Marco , Belfiore Maria Paola , Carella Carlo , Caranci Ferdinando , Cirillo Sossio
Published: April 2015

In Graves' ophthalmopathy (GO) it is important to distinguish acute inflammation at an early stage, responsive to immunosuppressive treatment, from inactive fibrotic end stage disease, unresponsive to the same treatment. The purpose of this study was to identify the most relevant signal intensities on orbital MR imaging with contrast administration both to classify patients according to their clinical activity score (defined by a cut-off value of 3) and to make a prediction of patient's CAS. Such threshold was considered as widely used in literature. Sixteen consecutive patients with a diagnosis of GO in different phases of thyroid disease based on clinical and orbital MR imaging signs, and six normal volunteers were examined. Orbital MR imaging was performed on a 1.5 Tesla MR Unit. MR scans were assessed by an experienced neuroradiologist, blinded to the clinical examinations. We found a statistical correlation between CAS and both STIR and contrast enhanced T1-weighted sequences. There was also a statistically significant correlation between STIR and contrast-enhanced T1 images disclosing the possibility of avoiding the injection of contrast medium. Our study proved that signal intensity values on STIR sequence increase in the inflammatory oedematous phase of disease. We confirmed the correlation between signal intensities on this sequence and CAS, showing an increase in signal intensity proportional to the CAS value. So we validated MRI use to establish the activity phase of disease more sensitively than CAS alone.
Endovascular Occlusion of Dural Cavernous Fistulas through a Superior Ophthalmic Vein Approach
Authors: Briganti Francesco , Caranci Ferdinando , Leone Giuseppe , Napoli Manuela , Cicala Domenico , Briganti Giuseppe , Tranfa Fausto , Bonavolontà Giulio
Published: April 2015

Dural cavernous fistulas are low-flow vascular malformations with usually benign clinical course and a high rate of spontaneous resolution. Cases with symptom progression must be treated with an endovascular approach by arterial or venous route. We report 30 patients with dural cavernous fistulas treated by coil embolization using surgical exposure and retrograde catheterization of the superior ophthalmic vein (SOV). The procedure resulted in closure of the fistula without other endovascular treatments in all 30 patients and clinical remission or improvement in 20 and eight patients, respectively. Embolization via a SOV approach is a safe and easy endovascular procedure, particularly indicated for dural cavernous fistulas with exclusive or prevalent internal carotid artery feeders and anterior venous drainage.
MRI DWI/ADC signal predicts shrinkage of lumbar disc herniation after O2–O3 discolysis
Authors: Perri Marco , Grattacaso Giuseppe , Di Tunno Valeria , Marsecano Claudia , Di Cesare Ernesto , Splendiani Alessandra , Gallucci Massimo
Published: April 2015

Purpose

Evaluate the discal morpho-structural changes as a predictive sign in the clinical outcome after ozone therapy in lumbar disc herniation using the T2–shine through effect in diffusion-weighted imaging (DWI).

Method

One hundred and fifty-four patients suffering from lumbosciatica (89 men and 65 women; age range, 23–62 years) were included, previous MR study performed with FSE-T2 and T2-fat, SE-T1 and DWI sequences, and were randomly assigned to two groups. Seventy-seven patients (control group) underwent conservative treatment with intraforaminal injection of steroid and anaesthetic. The remaining 77 patients (study group) underwent the same treatment with the addition of oxygen–ozone (O2–O3). During the following six months, a MRI follow-up with the same sequences was performed. An intervertebral disc volumetric analysis (IDVA), DWI signal score and post treatment clinical outcome evaluation were performed for an assessment of hernia reduction. χ2 test, Student's t test and analysis of covariance were used for comparison of variables.

Results

In the study group, 58 of 77 patients had a successful outcome (responders). In the responders group, DWI T2–shine through effect was present during MRI follow-up and in particular in 53 of 77 patients in six months of follow-up ( p < 0.05). Moreover, in the same group a statistically significant disc shrinkage was shown by IDVA in sixth months of follow-up ( p < 0.05).

Conclusions

T2–shine through effect in DWI is present before morphological disc reduction and moreover could be considered as a predictive sign of response to oxygen–ozone treatment.
Double Origin of the Posterior Inferior Cerebellar Artery Diagnosed by MR Angiography
Authors: Uchino Akira , Saito Naoko , Ishihara Shoichiro
Published: April 2015

The posterior inferior cerebellar artery (PICA) frequently arises from the fenestrated segment of the intracranial vertebral artery (VA), and this common variation can be misinterpreted as or confused with a PICA of double origin. Rarely, a PICA of true double origin occurs when two branches of the PICA arise separately from the intracranial VA and fuse to form an arterial ring. We discovered this rare variation incidentally while interpreting images of magnetic resonance (MR) angiography. This is the first report of MR angiographic findings of this rare variation.
Three-dimensional stereotactic atlas of the extracranial vasculature correlated with the intracranial vasculature, cranial nerves, skull and muscles
Authors: Nowinski Wieslaw L , Shoon Let Thaung Thant , Choon Chua Beng , Hnin Wut Yi Su , Yang Yili , Urbanik Andrzej
Published: April 2015

Our objective was to construct a 3D, interactive, and reference atlas of the extracranial vasculature spatially correlated with the intracranial blood vessels, cranial nerves, skull, glands, and head muscles.

The atlas has been constructed from multiple 3T and 7T magnetic resonance angiogram (MRA) brain scans, and 3T phase contrast and inflow MRA neck scans of the same specimen in the following steps: vessel extraction from the scans, building 3D tubular models of the vessels, spatial registration of the extra- and intracranial vessels, vessel editing, vessel naming and color-coding, vessel simplification, and atlas validation.

This new atlas contains 48 names of the extracranial vessels (25 arterial and 23 venous) and it has been integrated with the existing brain atlas.

The atlas is valuable for medical students and residents to easily get familiarized with the extracranial vasculature with a few clicks; is useful for educators to prepare teaching materials; and potentially can serve as a reference in the diagnosis of vascular disease and treatment, including craniomaxillofacial surgeries and radiologic interventions of the face and neck.
La discectomia percutanea per aspirazione
Authors: Belloni G. , Bonaldi G. , Moschini L. , Porta M.
Published: April 2015

Gli Autori riferiscono come il back pain tuttora presenti difficoltà sia diagnostiche che terapeutiche non risolte, verosimilmente per la complessità anatomo-funzionale delle strutture osteomio-legamentose che compongono la colonna vertebrale.

Fra le cause di lombalgia l'aumento della pressione intradiscale può rivestire un ruolo anche importante in considerazione delle diverse terminazioni sensitive situate sulla porzione esterna del disco. La nucleo-aspirazione secondo la tecnica di Onik rappresenta, in casi selezionati, un valido rimedio terapeutico.
Farmacocinetica dei mezzi di contrasto radiologici
Authors: Kormano M.
Published: April 2015

L'ampiezza e la durata dell'assunzione e dell'eliminazione dei mezzi di contrasto negli spazi extracellulari, mostra differenze tissutali specifiche, ma le variazioni fisiologiche e l'imprecisione delle misurazioni della tomografia computerizzata (TC) interferiscono con il loro uso diagnostico ai fini di caratterizzazione tissutale. Dopo una iniezione a bolo, si verificano rapidi cambiamenti nella distribuzione del contrasto, che però possono essere riconosciute solo con scansioni CT dinamiche. Dopo 2–3 minuti, l'aorta ed i tessuti normali mostrano un decremento parallelo nella concentrazione di contrasto. La diminuzione dell'accentuazione di contrasto nelle arterie può essere posposta con una rapida infusione del mezzo di contrasto stesso, e l'anatomia vascolare sarà così meglio visualizzata. Diversi nuovi prodotti presentano piccole differenze in farmacocinetica a livello renale ed epatico, ma tali differenze sono troppo modeste per essere utili a fini diagnostici.

A livello del sistema nervoso centrale la barriera ematoencefalica impedisce il contatto del mezzo di contrasto col tessuto nervoso normale ed il volume di distribuzione è ridotto. Per converso la relativa differenza di comportamento tra tessuto cerebrale normale e patologico è più ampia che altrove. Le differenze fra i diversi mezzi di contrasto sono pittosto modeste e sopratutto condizionate dalla farmacocinetica a livello del resto del corpo.
Mezzi di contrasto iodurati ionici e non-ionici in neuroradiologia: Aspetti farmaco-tossicologici
Authors: Corsico N. , Tirone P.
Published: April 2015

Sono stati confrontati gli effetti farmacotossicologici di alcuni mezzi di contrasto ionici e non-ionici sulle strutture nervose e sulle funzioni cerebrali.

I mezzi di contrasto non-ionici hanno esercitato una minor azione lesiva sulla barriera ematoencefalica e sono risultati meno neurotossici. In particolare hannno dimostrato un minore potenziale epilettogeno.

Sulla base dei risultati ottenuti si può presumere che la minor neurotossicità dei mezzi di contrasto non-ionici non sia dovuta soltanto alla minor osmolalità delle soluzioni, ma anche alla minor chemiotossicità della molecola.
Monitoraggio del liquor dopo esame mielografico in pazienti portatori di catetere spinale subdurale a permanenza
Authors: Di Spigna E. , Salesi M. , Cossu G. , Fregoso F.
Published: April 2015

In alcuni pazienti portatori di catetere spinale subdurale a parmanenza, impiantato per la somministrazione iterativa di oppioidi a scopo antalgico, si è eseguito il monitoraggio di alcuni parametri biologici del liquor dopo esame mielografico eseguito con contrasto organoiodato idrosolubile non ionico, iniettato attraverso il catetere medesimo.

Tale monitoraggio nel tempo è stato reso possibile grazie alla presenza del sistema impiantato a permanenza, che ha consentito di eseguire i ripetuti prelievi di liquor necessari allo studio, il quale ha evidenziato la assenza di importanti fenomeni irritativi a livello delle strutture nervose intratecali dopo indagine mielografica eseguita con Iopamiro 300.

I risultati ottenuti dalla valutazione dei dati bioumorali dei vari campioni di liquor confermano le qualità del mezzo di contrasto impiegato, fatto già osservato dal punto di vista clinico, come è riportato in letteratura.
L'angiografia diagnostica: Attuale validità nello studio delle neoplasie cerebrali
Authors: Rosa M.L. , Rivano C. , Donati P. Tortori , Capellini C. , Capello D.
Published: April 2015

Vengono prese in considerazione le caratteristiche angiografiche di 80 neoplasie diagnosticate e trattate dal 1984 al 1987 anche in relazione ai rillevi diagnostici ottenuti mediante TC e RM. L'esame angiografico è stato eseguito successivamente alle metodiche suddette al fine di: 1) migliorare o confermare la diagnosi di natura delle neoplasie, 2) valutare i rapporti tra neoplasia e strutture vascolari circostanti, 3) pianificare l'intervento chirurgico, in particolare la via di accesso e il tipo di intervento.

In base a questi criteri vengono passati in revisione i vari oncotipi e vengono discussi le attuali indicazioni dell'angiografia diagnostica.

In sostanza attualmente l'impiego dell'angiografia diagnostica trova minori indicazioni per quanto concerne la diagnosi di natura delle lesioni, ma risulta indispensabile in tutti i casi suscettibili di trattamento chirurgico.
RM e patologia vascolare del sistema nervoso centrale
Authors: Savoiardo M. , Sberna M. , Grisoli M.
Published: April 2015

La RM è diventata un metodo diagnostico essenziale per lo studio delle lesioni vascolari. Nelle ischemie, la RM è superiore alla TC nella dimostrazione degli infarti in fossa posteriore e delle lesioni della sostanza bianca periventricolare e sottocorticale delle persone anziane. Nell'emorragia acuta la TC è ancora l'esame di scelta, ma, dopo i primi due e tre giorni, la RM dimostra meglio tutta l'evoluzione dell'ematoma con aspetti specifici per i vari prodotti di degradazione dell'emoglobina. Tra le malformazioni vascolari, l'angioma cavernoso è particolarmente ben dimostrato dalla RM.