bluuebunny/crossref_metadata_2025 huggingface dataset:
Le sequenze Turbo-FLAIR nell'analisi volumetrica ippocampale nell'epilessia temporale farmaco-resistente
Authors: Ferone E. , Pierallini A. , Piattella M.C. , Bozzao A. , Prosperi D. , Giallonardo A.T. , Fantozzi L.M. , Bozzao L.
Published: April 2015

Scopo del lavoro è stato quello di valutare eventuali alterazioni della intensità di segnale e di volume della regione ippocampale in pazienti affetti da epilessia temporale farmaco-resistente utilizzando sequenze Turbo-FLAIR (Fluid Attenuated Inversion Recovery) e sequenze volumetriche pesate in T1.

A tale scopo abbiamo studiato 40 pazienti affetti da epilessia temporale farmaco-resistente utilizzando un apparecchio RM da 1,5 TESLA (NT 15 Philips «Gyroscan»). Sono state utilizzate sequenze Spin-Echo convenzionali, Turbo Spin-Echo, Inversion Recovery, Turbo-FLAIR e sequenze 3D volumetriche sui piani coronali, sequenze Spin-Echo convenzionali sui piani assiali e sagittali. L'intensità del segnale ed il volume della regione ippocampale sono stati valutati mediante analisi semi-quantitative automatiche eseguite con una workstation SUN. Abbiamo riscontrato una differenza significativa dei valori dell'intensità di segnale dei due ippocampi in 22 pazienti utilizzando le sequenze FLAIR. In 8 di questi pazienti non erano invece presenti differenze significative con le sequenze Spin-Echo convenzionali e Turbo Spin-Echo. L'analisi volumetrica ha mostrato un assottigliamento della corteccia dell'ippocampo in 12 dei 22 pazienti che presentavano anomalie dell'intensità del segnale.

I dati del presente studio suggeriscono una maggiore sensibilità delle sequenze Turbo-FLAIR nell'evidenziare alterazioni dell'intensità di segnale della regione dell'ippocampo.
Is Digital Subtraction Angiography Still the Method of Choice for Diagnosis and Follow-up of Cervical Artery Dissection?
Authors: Roncallo F. , Turtulici I. , Arena E. , Colucci M. , Gasparetto B. , Bartolini A.
Published: April 2015

Cervical Artery Dissection (CAD) accounts for up to one fifth of ischaemic strokes occurring before 45 years. The internal carotid artery is the most commonly affected vessel. Cerebral ischemia is the most serious consequence of carotid artery dissection. The enlargement of the artery may lead to laterocervical pain and direct compression of the lower cranial nerves and/or sympathetic peri-carotid plexus. A spontaneous dissection is assumed when no or only minor trauma preceded the onset. The pathogenesis of dissections remains unknown in most cases, but traumas and primary diseases of the arterial wall are the main predisposing factors.

We monitored six patients with CAD (four males, two females; 32–67 years old). All patients underwent US and CT-CTA examinations; five patients had DSA; four patients underwent MRI-MRA within the first two weeks after clinical onset. Four patients have received intravenous heparin treatment followed by oral anticoagulant therapy. Patients were then followed up with US alone (3 patients) or combined with CTA (3 patients) at 3 months to 2 years.

Three patients demonstrated a completed stroke in the middle cerebral artery territory (two patients) and in the posterior inferior cerebellar artery territory (one patient). Five patients had headache and/or cervicofacial pain. One had only neck and brachial pain. Four patients showed a Horner's syndrome alone (two patients) or associated with 9th, 10th, 11th and 12th cranial nerve involvement (one patient) or associated with stroke (one patient). One patient had brachial plexus motor impairment. Four patients had ICA dissection; one patient had VA dissection; one patient had multiple neck vessel dissection, that were correctly demonstrated by CTA and DSA in all cases. In five cases US overestimated the stenosis, showing a false occlusion pattern. MRI-MRA well displayedmural haematoma in the subacute stage, ipsilateral reduced intracranial blood flow and brain damage.

CADs are treated by heparin at the acute stage, although the benefit of such a potenially dangerous treatment has never been proven by a randomized trial. The favorable natural history of CAD emphasizes the need for a non-invasive approach to detection, monitoring and follow-up. A combined morphological and functional analysis of the brain and neck arteries is mandatory. Consequently DSA may be now replaced by US, MRI-MRA and CT-CTA. Because the three sets of CTA images correctly depict arterial wall and lumen without flow artifacts, this technique may be considered the new gold standard for the assessment of CAD.
Le Spondilodisciti in età pediatrica
Authors: Salviati L. , Monciotti C. , Turra S. , Gigante C. , Dei Rossi A. , Amistà P. , Carollo C.
Published: April 2015

La spondilodiscite è un processo infiammatorio a carico del disco vertebrale con variabile interessamento dell'osso confinante. è una patologia, benché rara, tipica dell'età pediatrica, la cui reale incidenza non è nota. L'eziologia è infettiva nella maggior parte dei casi, i segmenti più colpiti sono soprattutto le vertebre lombari, la via di diffusione è per lo più ematogena, a differenza delle forme dell'adulto, prevalentemente secondarie a manovre chirurgiche. La ricca vascolarizzazione disco-vertebrale nell'infanzia rende conto delle peculiari caratteristiche di questa patologia. I sintomi iniziali sono spesso aspecifici (febbre, dolore, disturbi della deambulazione), rara la leucocitosi, quasi costante l'elevazione degli indici di flogosi, emocoltura positiva in meno del 30% dei casi. 7 casi seguiti presso il nostro centro negli ultimi 8 anni. La diagnosi è stata posta mediante radiologia tradizionale, TC, RM in tutti i casi, e in 3 pazienti anche con biopsia TC-mirata, con follow up da 1 a 10 anni.

La spondilodiscite in età pediatrica è una patologia a prognosi favorevole, la RM è determinante per la diagnosi, il controllo a distanza è indicato per la valutazione degli esiti: ridotto accrescimento encondrale, cifosi focale, fusione intervertebrale.
Evaluation of Multiple Sclerosis Disease Activity by Diffusion-Weighted MR Imaging Preliminary Comparison with Contrast-Enhanced MR Imaging
Authors: Tsuchiya K. , Yoshino A. , Katase S. , Hachiya J.
Published: April 2015

The purpose of this study was to assess the utility of cerebral diffusion-weighted MR imaging in the diagnosis of multiple sclerosis (MS) in comparison with contrast-enhanced T1-weighted imaging. We reviewed T2-weighted spin-echo (SE), fluid-attenuated inversion-recovery (FLAIR), contrast-enhanced T1-weighted SE and echo-planar diffusion-weighted images (DWIs) obtained in ten patients with definite MS on 12 occasions.

In total, 83 plaques were demonstrated on T2-weighted SE and/or FLAIR images. Thirteen of these plaques showed enhancement on contrast-enhanced T1-weighted images and hyperintensity on DWIs. Five non-enhancing plaques showed hyperintensity on DWIs. Diffusion-weighted imaging, which provides information based on pathophysiology different from contrast-enhanced imaging, is a potential supplementary technique for characterizing MS plaques.
Diffuse Dural Enhancement and Sixth Cranial Nerve Palsy after Shunting Normal Pressure Hydrocephalus
Authors: Morgado C.M. , Cattoni M.B. , Gomes M.L.B. , Campos J.G.
Published: April 2015

We report a case of diffuse dural enhancement and sixth cranial nerve palsy after shunting normal pressure hydrocephalus with a high closing pressure system. Dural venous dilatation and cerebral displacement that accompany intracranial hypotension and reduced CSF are possible explanations for this picture that should not be mistaken for inflammatory or metastatic conditions.
99mTC-HMPAO-SPECT and Proton MR Spectroscopy in the Diagnosis of Alzheimer's Disease
Authors: Herminghaus S. , Hertel A. , Wittsack J. , Gorriz C. , Möller-Hartmann W. , Fröhlich L. , Dierks T. , Lanfermann H. , Zanella F.E.
Published: April 2015

This ongoing study evaluated the diagnostic accuracy of HPAO-SPECT and 1HMRS in the diagnosis of Alzheimer's disease. Both methods proved highly specific for diagnosis but post mortem validation of the clinical diagnosis is required for a final judgement on 1HMRS and HMPAO-SPECT.
Asymptomatic Subdural Hematoma or Subdural Collection MR Analysis
Authors: Kawata Y. , Takada O.
Published: April 2015

Because of widely available computed tomography and magnetic resonance imaging, the number of asymptomatic and/or minimally symptomatic cases of “incidental” subdural hematomas/collections apparently increased. MR images in sixteen cases of asymptomatic subdural space widening (aged 3 months to 84 years old) were reviewed. Etiology and clinical courses were correlated with MR findings. A rapid decrease in the brain volume presumably results in subdural space widening and subdural hematoma / collection because of rigid calvarium.
MR and CT Findings in Cavernous Sinus and Tributary Veno-Sinus Thrombosis
Authors: Schuknecht B.F. , Yüksel C. , Valavanis A.
Published: April 2015

We demonstrate cavernous sinus thrombosis and tributary veno-sinus thrombosis by high resolution CT and MR. Thin section (2mm) contrast enhanced high resolution CT scans obtained in eight patients with a diagnosis of a cavernous sinus thrombosis were compared to 30 normal controls.

In six patients CT scans were compared to 3-D spoiled gradient-recalled acquisition in the steady state (SPGR) sequences. Contrast enhanced CT of the cavernous sinus in eight patients differed from normal controls with respect to the size of filling defects that exceeded 7 mm in 78.6% of patients compared to 9.1% of controls. Thrombus formation accounted for a mean density of 26.7 ± 7.8 HU compared to −1.1 ± 12.3 HU in controls. Expansion of the cavernous sinus due to thrombosis was indicated by a significant increase in diameter (mean 10.8 mm) vs 8.3 mm in controls. Tributary veno-sinus thrombosis affected the superior ophthalmic vein and the inferior petrosal sinus in four patients each and the sphenoparietal sinus in two patients.

Thin — section CT and the contrast — enhanced SPGR MR sequences were equally suited to recognize cavernous sinus and tributary veno-sinus thrombosis. High resolution CT and MR findings indicate that tributary veno-sinus thrombosis not only affects the superior ophthalmic vein but may be more common than previously assumed.
Magnetic Resonance Imaging of Central Nervous System Involvement in Primary Sjögren's Syndrome
Authors: Al-Watban J. , Patay Z. , Bohlega S. , Larsson S.
Published: April 2015

We reviewed clinical, laboratory and MR findings in patients with primary Sjögren's syndrome whose initial clinical manifestations were related to CNS involvement. MR is highly sensitive in detecting CNS involvement in this syndrome. Imaging findings are not specific but may offer useful paraclinical information. The etiology of CNS lesions in Sjögren's syndrome is discussed.
CT and MRI Findings of Central Neurocytoma
Authors: Kong S.-C. , Chen C.C.-C. , Shen Wu-Chung , Lee S.-K. , Wen M.-C.
Published: April 2015

Central neurocytoma (CN) is a rare but usually benign cerebral intraventricular tumor of young adults which can be confused with oligodendroglioma and other neoplasms. A retrospective review of the CT and MRI findings in five pathologically confirmed cases shows that CN frequently demonstrates a characteristic attachment to the septum pellucidum and confinement to the lateral and third ventricles. The tumor presented as a hypo-, iso- or hyperdense mass on CT, a low, iso- or high-signal intensity on T1WI, and a high-signal intensity on T2WI when compared to the brain gray matter with mild to moderate contrast enhancement. No tumor contained calcification, and only two of them showed cyst-like areas. In one case, hemorrhage was present in both the tumor and the ventricles.

The results indicate that CN can still be suggested radiologically and does not necessarily contain calcification or cyst-like areas. Preoperative diagnosis of CN may prove of value for planning therapy, because this tumor seems to have a better prognosis than other intraventricular tumors.
CT and MR Features of Multiple Gliomas
Authors: Lafitte F. , Precetti S. , Martin-Duverneuil N. , Piotin M. , Guermazi A. , Brunet E. , Spelle L. , Chiras J.
Published: April 2015

We analysed the CT and MR features of multiple gliomas, and determined the best imaging modality for the initial diagnosis. CT (seven scans) and MR imaging (nine scans) of nine patients with proven multifocal malignant gliomas were reviewed by two neuroradiologists. The lesions were usually hypodense on CT (64%), hypo or isointense on T1-W images (81%), and hyperintense on T2-W images (95%). Edema and mass effect were usually moderate or absent.

After contrast media administration, the enhancement was mostly strong (64% on CT and 81% on MR), often heterogenous. MR features of the different lesions in one patient were often different (67%). Meningeal enhancement, suggestive of a possible way of dissemination, was rare. MR allowed detection of six lesions overlooked by CT. In the case of multiple cerebral masses, multiple gliomas should be considered as a possible diagnosis as well as brain metastases, abcesses or multifocal lymphomas. Moderate edema and mass effect associated with strong and heterogenous enhancement are evocative. MR is more sensitive than CT for the detection of the lesions, but rarely allows visualization of a dissemination route.
Stereotactic Biopsy versus Proton Spectroscopy in the Diagnosis of Malignant Gliomas
Authors: Herminghaus S. , Möller-Hartmann W. , Marquardt G. , Wittsack J. , Labisch C. , Dierks T. , Lanfermann H. , Zanella F.E.
Published: April 2015

We assessed the value of 1HMRS in the diagnosis of astrocytomas and glioblastomas compared with stereotaxic biopsy. 1HMRS is an alternative non-invasive diagnostic tool to predict the presence of malignant gliomas.
Correlation of Functional MR Imaging with Perimetric Examination in Patients with Visual Field Defects Due to Lesions Involving the Afferent Visual System
Authors: Kollias S.S. , Golay X. , Christoforidis G.A. , Landau C. , Valavanis A.
Published: April 2015

We assessed fMRI in the objective evaluation of visual function during treatment planning and postoperative follow-up in patients with occipital lobe and/or the afferent visual system lesions. Ten normal volunteers and eleven patients harbouring brain lesions with MR evidence of calcarine cortex and/or visual pathway damage underwent ophthalmoscopy, Goldmann perimetry and fMRI examination. Blood oxygenation sensitive series (gradient-echo, T2*-weighted, single-shot EPI: TR = 2 sec, TE ? 40 ms, FA = 40°, voxel volume 3.1 mm × 3.1 mm × 5 mm) were obtained using a 1.5-Tesla clinical imager with six contiguous slices, covering the occipital lobe parallel to the calcarine fissure. A repetitive, phasic experiment for visual stimulation was achieved using a binocular, stroboscopic, white light flashing at 10 Hz and was repeated twice to test reproducibility. Functional maps, generated using a cross correlation technique, were overlaid onto concurrent high resolution anatomic MR images and compared to Goldmann perimetry results. All volunteers demonstrated symmetric, bilateral, regional signal intensity changes (2%-5%) between photic stimulation and darkness in the primary visual cortex and dorsolateral and ventrolateral extrastriate areas. Cortical activation maps in ten patients clearly localised asymmetric response within specific regions in the primary visual cortex and correlated with Goldmann perimetry results. Displacement of the eloquent calcarine cortex was demonstrated in a patient with normal perimetry results. Primary visual area activation increased in two patients following surgery. fMRI performed on a conventional MR system can objectively evaluate visual function in neurosurgical patients with occipital lobe and/or afferent visual system lesions as part of treatment planning and postoperative follow-up.
Collateral Capacity of the Circle of Willis in Patients with Planned Sacrifice of the Internal Carotid Artery
Authors: Schumacher M. , Hetzel A. , Von Reutern G.-M. , Wernz M. G. , Droste D. W.
Published: April 2015

To evaluate the accuracy of Doppler sonography compared with angiography, temporary test occlusion of the internal carotid artery (ICA) was performed as paramenter for prediction of tolerance in case of sacrifice of the ICA. The vessel occlusion was done in 67 patients by manual compression over 10 seconds and by twenty minutes lasting balloon insufflation.

The results (table 1) show a good correlation between dopplersonographic and angiographic testing in terms of collateral circulation. However, Doppler sonography proved to be more indicative for predicting clinically insufficient collateral supply.
Emergency MRI in Clinical Peracute Brain Stem and Hemispheric Stroke
Authors: Fitzek C.M. , Fitzek S.C. , Hopf H.C. , Stoeter P.
Published: April 2015

We show the capability and results of MRI examinations of peracute brainstem and hemispheric stroke patients in clinical emergency situations. The hypothesis that CT scan is faster and more accurate under this conditions is to be disproved.
Cerebral Venous Thrombosis: Relations between the Extension of the Thrombosis and Parenchymal Damage
Authors: Bergui M. , Bradac G.B. , Daniele D. , Gozzoli L. , Stura G.
Published: April 2015

Prognosis of cerebral venous thrombosis (CVT) changed in recent years from a life-threatening to a more benign condition. Anticoagulation therapy “freezes” the evolution of the disease, preventing progression to extensive brain lesions.

Good outcomes reveal a wide range of lesions; moreover, neuroradiological investigations allow a precise evaluation of dural sinuses and deep venous system. With this background we tried to correlate the extension of the thrombosis in dural sinuses and deep venous system with the brain lesions in 24 patients with CVT and found no clear correlation.

On the other hand, in particular cases a relation between thrombosis of cortical veins or deep medullary veins and brain lesions was found. The availability of alternative venous drainage probably explains the different extension of brain lesions in our patients. According to data from the literature cortical and deep medullary veins may represent “critical” locations for collateral venous circulation in CVT.
Selection Criteria for Intra-Arterial Thrombolytic Therapy by Initial SPECT
Authors: Ueda T. , Nochide I. , Kumon Y. , Sakaki S. , Yuh W.T.C. , Maley J.E. , Hahn P.Y.
Published: April 2015

We determined the selection criteria for intra-arterial thrombolytic therapy by initial single-photon emission-computed tomography (SPECT) using 99mTc-HMPAO. We studied 30 patients who were obtained early complete recanalization of the internal carotid territory occlusion. The residual CBF of non-infarction, infarction and hemorrhagic lesions judged by follow-up CT scan was evaluated semiquantitatively by calculating two parameters with pretherapeutic SPECT: the ischemic regional activity to cerebellar activity ratio (R/CE ratio) and asymmetry index (AI). The patient's neurological exam was evaluated according to the NIH stroke scale score. The patients were classified by follow-up CT into three groups: A) nine patients who had no or small infarction; B) fourteen patients who had medium or large cortical infarction; C) seven patients who had hemorrhagic transformation. No significant difference was observed in the interval from onset, UK doses, or site of occlusion between each group. However, the residual CBF and the NIH scores 1 month later in group C were significantly worse than those in group A or B. Forty-two lesions were identified (22 reversible ischemia, 13 infarction, and 7 hemorrahge). The residual CBF and neurological outcome were significant among three types of lesions. Tissue reversibility at any given time rather than duration of ischemia remains the most important factor to influence outcome. Pretreatment SPECT can assess tissue reversibility and increase the efficacy of intra-arterial thrombolysis for acute stroke patients.
Hemodynamic Effects of Middle Cerebral Artery Stenosis and Occlusion
Authors: Derdeyn C.P. , Powers W.J. , Grubb R.L.
Published: April 2015

Middle cerebral artery (MCA) stenosis and occlusion may cause ischemic symptoms through both hemodynamic and embolic mechanisms. The purpose of this investigation was to determine the hemodynamic effects of these lesions. Ten patients with angiographically confirmed symptomatic occlusion (n ? 5) or stenosis (n = 5) of the Ml segment of the MCA were studied with clinical evaluation, arteriography, and positron emission tomography (PET). Hemodynamic status was categorized by PET as: Stage 0, normal hemodynamics; Stage 1, autoregulatory vasodilatation (increased MTT); and Stage 2, increased OEF. Of five patients with MCA occlusion, three had autoregulatory vasodilatation (Stage 1) and 2 demonstrated increased OEF distal to the lesion (Stage 2).

The MCA territory was supplied solely by pial collaterals in all five patients. Four of the five patients with focal MCA stenosis had normal hemodynamics (Stage 0). One patient was categorized as Stage 1. The frequency of hemodynamic compromise in patients with MCA occlusion is high. Pial collateralization is not a specific sign of increased OEF in patients with MCA occlusion.
La Xenon-TC: Indicazioni, limiti, vantaggi
Authors: Piovan E. , Pizzini F. , Alessandrini F. , Zampieri P. , Beltramello A.
Published: April 2015

La TC-perfusionale con gas Xenon stabile permette la quantificazione della perfusione ematica cerebrale e la rappresentazione di mappe vascolari con buona risoluzione. L'indagine viene espletata usando un normale apparecchio TC implementato con apposito inalatore e le immagini vengono elaborate sfruttando uno specifico software. La risoluzione ottenibile può essere paragonata a quella degli apparecchi PET e SPET; rispetto a quest'ultimo tuttavia fornisce valutazioni di perfusione assolute. Vengono prese in considerazione le diverse alterazioni studiate con tale metodica nell'esperienza personale che includono: patologia vascolare (ischemia, malformazioni artero-venose, aneurismi), patologia degenerativa (Alzheimer, Parkinson, idrocefalo normoteso), patologia traumatica cranio-cerebrale e patologia neoplastica.
Il ruolo diagnostico-terapeutico della terapia infiltrativa antalgica nelle sindromi algiche di origine lombare
Authors: Ferrito G. , Scazzeri F. , Prosetti D. , Augusti A. , Marconi F. , Cantini R. , Lepori P. , Salvadori R. , Quilici N.
Published: April 2015

La notevole incidenza del dolore lombare costituisce spesso un problema sia diagnostico, relativamente alla ricerca della causa dolore, che terapeutico per quanto concerne l'indicazione al trattamento più idoneo. Infatti il successo del trattamento dipende da una accurata diagnosi ma è spesso difficile trovare una diretta correlazione tra sintomatologia clinica e tipo di processo patologico.

Varie sono le cause, rachidee ed extra-rachidee di dolore lombare eventualmente irradiato agli arti inferiori, ma le faccette articolari interapofisarie sono certamente le maggiori responsabili.

Riportiamo la nostra esperienza nel trattamento, antalgico, ambulatoriale del dolore di origine vertebrodiscale con blocco farmacologico anestetico-cortisonico delle faccette articolari posteriori e con infiltrazione epidurale per via sacrale. Si sottolinea anche il valore diagnostico del blocco anestetico delle faccette articolari.
Atypical Magnetic Resonance Features of Intracranial Meningioma
Authors: Tsitouridis J. , Demertzis J. , Karidas M. , Papastergiou C. , Kosmatopoulos F.
Published: April 2015

A small number of intracranial meningiomas have atypical MR appearance which can lead to misdiagnosis. We present the MR features of 14 atypical meningiomas.

Meningiomas characterized as atypical either because of their MR features (extensive necrosis, association with large cysts or neoplasms, haemorrhage, scarring) or their location (intradiploic, intraventricular, extradural extension). Four cases (28,5%) were misdiagnosed initially as other lesions based on MR findings alone. In all cases with MR atypicality the diagnosis was confirmed surgically.
Meningeal Carcinomatosis of the Cerebellopontine Angle and Internal Auditory Canal
Authors: Duca S. , Salzedo E.
Published: April 2015

Most CPA and IAC region neoplasms are benign. Malignant tumour represent about 2% of the lesions and metastatic lesions account for 0.2 to 2% of all neoplasms of this region. In a group of 82 patients with meningeal carcinomatosis, 11 patients (16%) with PCA and IAC metastatic lesions were identified. In three cases the original tumour was a breast carcinoma, while in the other eight cases it was a sarcoma, PNET, glioma, leukaemia, lymphoma, medulloblastoma and one tumour of unknown origin. In five cases both PCA and IAC presented abnormal contrast enhancement of nodular type; in four patients only IAC and in two only PCA were involved. IACs were involved bilaterally or monolaterally in four cases each, while PCAs presented bilateral involvement in five cases and monolateral in one. In two cases bilateral Vth cranial nerves and cavernous sinuses were present and all the patients had dural or leptomeningeal carcinomatosis outside the PCAs and IACs.

Unlike literature reports in which only 25% of IACs carcinomatosis have a negative clinical picture, we found clinically tested hearing pathology, in only 1/11 patients, and involvement of other cranial nerves in only 2/11 patients. From the MR point of view, CPA and IAC carcinomatosis is characterized by bilateral or, less frequently monolateral nodular or linear contrast enhancement inside the IAC and along the dural lining of the CPA and it usually not visible in non contrast SE T1 and T2 sequences.

Carcinomatosis is always associated with more diffuse dural or leptomeningeal secondary neoplastic involvement, but the association with other cranial nerve carcinomatosis is not the rule. The more frequent involvement of these regions may depend on the length of the VIIth and VIIIth cranial nerves (and this observation may also explain the more frequent association with Vth cranial nerve carcinomatosis) and on the volume of the CPA cistern, that allows a more diffuse and longer contact between the nerves and the meninges and the metastatic lesions floating in the cerebrospinal fluid.
Magnetic Resonance Myelography at 0.5 T
Authors: Micheli C. , Gallucci M. , Cardone G. , Gagliardo O. , Paluello G.B. Minio , Castrucci M.
Published: April 2015

The aims of this study were to evaluate the clinical usefulness of magnetic resonance myelography (MR-M), to suggest technical improvements and to evaluate the results obtained by comparing them with conventional MRI and conventional myelography.

A series of 14 healthy volunteers and 43 patients with myelinic or radicular disease were studied by conventional MR and MR-M on an 0.5T unit using sequences pre-optimized for the acquisition of myelographic images.

MR-M did not modify the diagnosis made by conventional MRI in cases of myelinic or radicular compression, but it did provide useful additional information in 38% of cases. It provided no additional information on compressive disease. Similar results in terms of quality of information were obtained from the correlation with conventional myelography.

In our opinion, MR-M is useful only for cases of discal or spondylogenetic disease.
Organizzazione della corteccia somato-sensoriale secondaria
Authors: Tartaro A. , Antonazzo R. , De Matthaeis P. , Del Gratta C. , Della Penna S. , Ferretti A. , Torquati K. , Colosimo C. , Romani G.
Published: April 2015

Localizzare e possibilmente evidenziare l'organizzazione somatotopica delle aree somatosensoriali secondarie (SII) con risonanza magnetica funzionale (fMRI) mediante stimolo elettrico applicato agli arti superiori e inferiori.

9 soggetti normali (età media 31 anni), previo consenso informato, sono stati addestrati a rimanere immobili (evitando anche i movimenti oculari) e rilassati sia nella fase di assenza (rest) che di somministrazione (task) di uno stimolo elettrico pulsato della durata di 200 (sec, applicato mediante elettrodi Cu/Sn al polso ed al malleolo interno, unilateralmente. La frequenza dello stimolo è stata di 1,9 stimoli/s. Sono stati stimolati i nervi misti cutanei e propiocettivi mediano e tibiale destro e sinistro. Le immagini funzionali sono state acquisite con tecnica eco-planare in grado di fornire 22 strati contigui, di 3 mm di spessore (matrice 128 × 128) in 2 sec, posizionati parallelamente al piano bicommissurale, dal vertice fino al giro temporale superiore incluso. Il paradigma prevedeva 6 fasi (3 di rest e 3 di task) di 10 acquisizioni ciascuna con delay di 4,5 s.

In tutti i soggetti sono state evidenziate aree di attivazione corticale a livello parietale controlaterale all'arto stimolato (aree somatosensoriali primarie e associative). Un significativo aumento di segnale è stato localizzato nel margine superiore della scissura silviana, sia ipsi che controlaterale.

La fMRI è in grado di rilevare l'attivazione della corteccia somatosensoriale primaria durante stimolazione elettrica periferica. L'aumento di segnale rilevato nel piede della corteccia parietale, nel tratto corrispondente al margine superiore della scissura silviana, riflette l'attivazione dell'area SII.
Meningioma of the Lateral Ventricle in a Young Adult
Authors: Roncallo F. , Bisio N. , Mortara M. , Ravetti J.L. , Bartolini A.
Published: April 2015

Intraventricular neoplasms are uncommon CNS masses, representing only 10% of all tumours. Previous studies of intraventricular neoplasms have shown consistent trends in tumour location and in the age of patient presentation. Within the lateral ventricle, specific regions can be identified as sites of predilection for each particular tumour. It was found that these tumours tend to occur in natural age-related groupings. Meningiomas of the lateral ventricles of the brain are rare tumours. The incidence of this tumour type is very low, since they account for only 0.2% of all intracranial neoplasms and 0.5–5% of all intracranial meningiomas. We present a case of an intraventricular meningioma arising from the trigone in a young adult and discuss the available literature on intraventricular meningiomas and its differential diagnosis.
Neuroradiological Aspects of Non Acoustic Tumours of the Cerebellopontine Angle
Authors: Finizio F.S. , Frank G. , Presutti L. , Cunsolo E.
Published: April 2015

We present a series of 17 non acoustic tumours of the cerebellopontine angle. They include ten meningiomas, five epidermoid cysts, one cavernous haemangioma and one cholesterinic cyst. In all cases histological verification was obtained at surgery. Evaluating the results of both CT and MRI studies, an accurate pre-operative diagnosis could be made in most cases. Meningiomas usually present as lesions with a semilunar shape, eccentric to the IAC, with smooth margins. The meningeal sign is usually observed while calcifications may he absent. On CT scan, the lesions were hypodense before contrast administration with a homogeneous marked enhancement after i.v. contrast administration. On MRI, on T1 WI the lesions were isointense and hyperintense on T2 WI. All cases markedly enhanced following gadolinium administration. Epidermoid cysts on CT were cystic hypodense lesions with a typical peripheral rim of enhancement. On MRI, they were hypointense on T1 WI and hyperintense on T2 WI. The typical peripheral rim of enhancement after GD-DTPA administration was also observed. Cholesterinic cyst was a well defined cystic lesion involving the petrous apex on CT. On MRI the typical increasing signal on both T1 and T2 WI was observed. In contrast to other lesions that require extensive surgery, the treatment of cholesterinic cyst may consist in simple drainage. Cavernous haemangiomas is a very rare lesion arising in the region of the geniculate ganglion of the facial nerve and may spread medially to involve the CPA. On CT, a stippled pattern of calcifications and contrast enhancement is observed. On MRI, the lesion is bright on T1 and T2 WI with gadolinium enhancement. The entire brain must be explored because other cavernous haemangiomas may also coexist.
Immunoscintigrafia con frammenti anticorpali monovalenti anti-granulociti marcati con 99m Tc: aspetti diagnostici in un caso di ascesso cerebrale
Authors: Dimonte M. , Di Pierro G.
Published: April 2015

Per tipizzare con relativa sicurezza una lesione cerebrale focale, è spesso necessario integrare TC e RM con tecniche funzionali di imaging quali quelle scintigrafiche.

Nel presente lavoro riportiamo un caso in cui l'accertamento definitivo, non invasivo, di un ascesso cerebrale complicante una otite media colesteatomatosa omolaterale, è avvenuto mediante SPECT cerebrale con frammenti Fab' monoclonali anti-granulociti marcati con 99mTc (LeukoScan).

Mentre l'impiego in campo neurochirurgico della tradizionale scintigrafia con leucociti autologhi è ben documentato, non abbiamo invece potuto riscontrare in letteratura casi di infezioni cerebrali diagnosticate mediante immunoscintigrafia.

La semplice e rapida marcatura in vivo dei granulociti neutrofili mediante frammenti Fab' di anti-corpi specifici per l'antigene di membrana NCA-90 (LeukoScan), rende tale metodica immunoscintigrafia una valida alternativa alla complessa e poco disponibile leucoscintigrafia, e fa prevedere possibili interessanti applicazioni anche in ambito neurochirurgico.
Idiopathic Hypertrophic Cranial Pachymeningitis
Authors: Roncallo F. , Turtulici I. , Bonaldo A. , Bisio N. , Bartolini A.
Published: April 2015

Hypertrophic cranial pachymeningitis is a rare, idiopathic form of granulomatous pachymeningitis. To understand the modes and mechanism of meningeal involvement in various disease processes that affect the different layers of the meninges, one needs to be familiar with the anatomy of the meninges and the pathophysiology of the blood-brain barrier.

The anatomy of the meninges and the pathophysiology of bood-brain barrier justify two distinct patterns of meningeal enhancement: leptomeningeal and pachymeningeal; dural meningeal enhancement is categorised as diffuse, linear only or linear and nodular, and focal.

Diffuse dural enhancement was defined in our patient as an intense and continuous dural enhancement as seen on MR imaging, encompassing at least 75% of the dural surface.

Other causes of dural thickening include epidural abscess, rheumatoid arthritis, lymphoma, neurosyphilis, sarcoidosis, tuberculosis, Wegener's granulomatosis and intracranial fibromatosis. HTLV-1 infection and chronic dialysis have also been reported to cause granulomatous thickening of the pachymeninges. Intense enhancement of the normal dura mater following gadolinium injection has been seen in cases of intracranial hypotension and the marked dural enhancement resolves with treatment of the intracranial hypotension. Pachymeningeal thickening has been reported with orbital pseudotumour and in a case of multifocal fibrosclerosis. Idiopathic hypertrophic pachymeningitis is thus a diagnosis of exclusion. The most common symptoms are headache and cranial nerve palsies. Cerebellar ataxia has been reported in some patients.

The treatment of hypertrophic cranial pachymeningitis is not well defined, owing to the rarity of the disease and uncertainty regarding its aetiology. At present, high-dose corticosteroid therapy is the treatment of choice, followed by immunosuppressive agents, such as azathioprine and cyclophosphamide, if necessary.
What Is It?
Authors: Moro M. , Curtolo S. , Di Paola F. , Baratto V. , Giannini C. , Longatti P.L.
Published: April 2015

Gli autori descrivono un caso inusuale di condroma intracranico non originante dalla base cranica, bensì dalla falce cerebrale. Il tumore appariva radiologicamente e chirurgicamente ben demarcato dal parenchima circostante. I reperti TAC, RMN e angiografico consentivano di ipotizzare tale diagnosi rispetto a un meningioma e l'esclusione di una lesione metastatica.
A New Combined System for Angiography and Computed Tomography Technique and First Applications
Authors: Schumacher M. , Husstedt H. , Zarfl A.
Published: April 2015

A new diagnostic tool was developed combining DSA-equipment with a CT scanner. The two components of the system can be separated by a sliding lead wall allowing four modes of application: completely separate use, combination of fluoroscopic plane with CT, coupling DSA with CT or DS-cisternography with CT-cisternography. According to these modalities the system components can be used for different diagnostic purposes especially prior, during or after interventional procedures. Applications are described in the treatment of aneurysms regarding the measurement of aneurysm size.
Evaluation of Empty Sella in Patients with Cerebral Arteriovenous Malformations
Authors: Yüksel C. , Chen J.J. , Kollias S. , Christoforidis G. , Valavanis A.
Published: April 2015

To evaluate the incidence of empty sella in patients with cerebral arteriovenous malformations we retrospectively evaluated the pituitary gland height (PGH) on midsagittal T1 -weighted images in 216 patients with cerebral AVM (37.5% female, 62.5% male, mean age 33.4). Complete empty sella was defined as PGH<2 mm and partial empty sella as PGH<3 mm. Empty sella in patients with cerebral AVMs was analysed on the basis of nidal size, nidal location and age. We compared our results with those found in a normal population.

Mean PGH in our patient population was 3.96 mm (range 1–9 mm). 3.4 mm in males and 4.8 mm in females. The overall incidence of empty sella was 41.2% (89/216). Empty sella occurred in 32% (48/150) of patients less than 40 years old and 62% (41/66) of patients over 40. The distribution of mean PGH values in AVM patients grouped by age was lower than but parallel to the distribution in normal PGH values. A statistically significant increased incidence of empty sella was found with cortical AVM location (48%; 69/144, p<0.0001), and nidal size> 3 cm (60%; 75/125, p<0.0001). Our results indicate that empty sella occurs more frequently in patients with cerebral AVM especially with a cortical location or a nidus greater than 3 cm. We conjecture that this may be related to altered CSF flow dynamics in these patients. Further studies may explain the higher incidence of empty sella in patients with cerebral AVM.
CT Fluoroscopy-Guided Interventions in Intracranial Disease
Authors: Katada K. , Kato R. , Anno H. , Ogura Y. , Koga S. , Nonomura K. , Hayakawa M. , Kanno T.
Published: April 2015

Real-time CT fluoroscopy (CTF), which permits real-time monitoring of CT images at a rate of 8 images per second with a 0.5 s delay time, has recently entered clinical use. The purpose of this paper is to evaluate the usefulness of CTF as a tool for guiding intracranial interventions.

Twenty-six interventional procedures were undertaken in 16 patients under CTF guidance. These included puncture of intracranial hematoma (n=8), hematoma drainage (n=9), cerebrospinal fluid (CSF) drainage (n=3), biopsy of intracranial tumors (n=4), and marking of intracerebral tumors (n?2).

Needle puncture and placement were clearly monitored by CTF in all the cases. Hematoma puncture and drainage, CSF drainage, and tumor marking were performed successfully under CTF guidance. Biopsy failed in one patient with suspected brain tumor. Intra- and extra-tumor bleeding was observed in two patients who underwent tumor biopsy and was detected by CTF immediately after the occurrence.

Our preliminary study indicates that real-time CTF is a potentially valuable tool for guiding neurosurgical interventions.
MR Imaging of Spinal Arteriovenous Malformations and Fistulas before and after Embolization
Authors: Hasuo K. , Mihara F. , Oguri S. , Ishioka H. , Numaguchi Y.
Published: April 2015

We evaluated MR myelography (MRM) and MR angiography (MRA) in addition to MRI before and after embolization of spinal arteriovenous malformations (AVMs) and fistulas (AVFs). Thirteen patients underwent MRI before and after embolization. Among these, MRM was performed in 7 cases and MRA in 8. MRM was performed with 2D-fast SE sequences and MRA with 3D-PC sequences following injection of Gd-DTPA. In all intramedullary AVMs, nidus, dilated draining veins and hemorrhage were visualized on MRI MRM and MRA were thought to be useful, but they were not essential for making the diagnosis. In perimedullary and dural AVFs, dilated draining veins and T2-prolonged areas in the cord were visualized, but the fistula itself could not be detected by MRM or MRA. MRM was very sensitive in detecting dilated draining veins around the spinal cord. After embolization, cord enhancement was observed for a relatively long period in patients having dural AVFs with poor clinical results. Closure of the fistula was suggested by marked vascular enhancement presumably due to stagnant flow following feeding vessel occlusion. It could also be verified by disappearance of draining veins on MRA. Verification of fistula closure was difficult using MRM since dilated veins did not rapidly decrease in size and mild dilatation persisted for a long period. MRM and MRA were effective in detecting recurrence. MRM and MRA in addition to MRI are useful in the diagnosis and follow-up of spinal AVMs and AVFs before and after embolization.
Endovascular Therapy and Gamma Radiosurgery in Brain AVMs
Authors: Lemme-Plaghos L. , Ceciliano A. , Garbugino S. , Antico J. , Chinela A. , Bunge H.
Published: April 2015

Superselective embolization (SE) and Stereotactic Radiosurgery (RS) are established therapeutics for cerebral arteriovenous malformations (AVMs).

Their sequential use has been proposed by several authors.

92 cases with complete follow-up after treatment with SE (using IBCA or NBCA) and RS were analysed.
Complications in Endovascular Treatment and Conventional Angiography for Vertebral Dissecting Aneurysms Presenting Subarachnoid Haemorrhage
Authors: Tsuura M. , Terada T. , Kinoshita Y. , Yokote H. , Hyoutani G. , Ryujin Y. , Nakai K. , Itakura T.
Published: April 2015

We report complications and problems in endovascular treatment and conventional angiography in 11 cases of intradural vertebral dissecting aneurysms presenting subarachnoid haemorrhage. There were four complications related to the interventional procedure and conventional angiography. In 3 patients (27%), VDAs ruptured immediately after injection of contrast media or hypertension during the interventional procedure, which caused respiratory arrest. In a case of bilateral VA dissection (9%), after proximal VA occlusion had been performed for unilateral VDA, contralateral dissection extended to the basilar artery resulting in brain stem infarct. We suggest that the incidence of rebleeding of VDA during angiography and embolisation is higher than that of the usual saccular aneurysms. Careful injection of contrast media and strict blood pressure control seems to be more important to prevent rebleeding in VDAs than intracranial saccular aneurysms. Since unilateral VA occlusion may extend contralateral dissection in a case of bilateral VA dissection, it is necessary to check contralateral VA dissection before VA occlusion.
Magnetic Resonance Imaging following Treatment of Aneurysmal SAH by Neurosurgical Clipping or Endovascular Coiling: Comparison of Parenchymal Damage with Cognitive Outcome
Authors: Hadjivassiliou M. , Tooth C.L. , Romanowski C.A.J. , Powell T. , Byrne J. , Battersby R.D.E. , Oxbury S. , Mayes A.R. , Sagar H.J.
Published: April 2015

The relative contribution to cognitive outcome of haemorrhage and surgery following aneurysmal subarachnoid haemorrhage has been assessed using a battery of cognitive tests and magnetic resonance imaging one year after the procedure. To tease out the effect of surgery we have used 40 case-matched patients treated with endovascular coiling as controls.

Surgery resulted in greater areas of structural damage than endovascular coiling. Both the surgical and the coiled groups were cognitively impaired on a broad range of cognitive tasks. When comparing the coiled and clipped groups there is a trend towards a poorer cognitive outcome amongst the surgically treated patients. Cognitive outcome following aneurysmal subarachnoid haemorrhage is primarily dictated by the haemorrhage. This first comparison of the two techniques, however, suggests that endovascular coiling may be more advantageous than surgery in the treatment of aneurysmal subarachnoid haemorrhage.
MRI Patterns of Leigh Syndrome
Authors: Sintini M. , Giustina E. Della , Mavilla L.
Published: April 2015

To emphasize the varied clinical, neuroradiological and biochemical/genetic features of Leigh syndrome (LS). 3 cases with different metabolic anomalies and a family with 5 members affected by the same biochemical/genetic abnormality had 2 to 4 years follow-up with a 1.5 unit.

Cases 1 and 2 had respectively pyruvate dehydrogenase (PDH) and activated Complex I defect; both presented at birth with seizures and brainstem involvement and developed microcephaly and quadriparesis. MRI showed rapid, progressive cortical atrophy with transient subdural fluid collections (case 1), and haemorrhagic necrosis of both thalami and central mesencephalon (case 2). Case 3 started at the 5th month of life with seizures, hypotonia, brainstem signs, and was found to have a defect of Complex II of the mitochondrial respiratory chain; MRI disclosed transient subdural fluid collections, necrosis of the basal ganglia at first, and of brainstem and subcortical white matter soon afterwards. Of the five members of a family with the so called NARP mutation only two had symptoms of brain involvement: an infant who developed at four months of age hypotonia, epilepsy, mental/motor regression and retinitis pigmentosa, had MRI pictures of putaminal, cerebellar, brainstem necrosis along with hypomyelination of the cerebral hemispheric white matter. His aunt of 28 who, after presenting when 1 year old with a Lennox- Gastaut syndrome, suffered from mental delay, ataxia, pigmentary retinopathy, displayed a severe brain atrophy, mostly cerebellar, at MRI.

The peculiar variability of Leigh syndrome is stressed and confirmed, with emphasis on case 2.
Facial Capillary Malformation, Ocular Anomalies and Cerebral Developmental Venous Anomalies
Authors: Boukobza M. , Enjolras O. , Beylot C. , Merland J.-J.
Published: April 2015

To describe an uncommon vascular syndrome combining a facial Port-Wine-Stain (PWS) in the ophthalmic V1 trigeminal area, without evidencing the pial vascular malformation and subsequent cerebral lesions.

Six patients with facial PWS, comprising the ophthalmic V1 location, underwent clinical studies, plain radiographs and CT. Cerebral angiography was carried out in 4 patients, MR in 3, and MR, enhanced-MR and MR angiogram in 2 other cases.

All 6 patients had a facial PWS with V1 involvement, ocular anomalies (glaucoma or choroid angioma), ipsilateral to the facial port-wine-stain in 3 cases and bilateral in 3 cases, and extensive supratentorial DVAs. In all cases clinical examination was normal and no stigmates of leptomeningeal angioma, no brain anomalies were detected on radiological studies.

We focus on this particular vascular syndrome, a variant of classic SWS, with excellent brain tolerance, in contrast to what happens to patients with a leptomeningeal vascular malformation.
The Role of Intravascular EEG
Authors: Asensio S. García , Guelbenzu S. , Uclés P. , Barrena M.R. , Valero P.
Published: April 2015

In presurgical evaluation of temporal lobe epilepsy, invasive methods of recording are necesary if noninvasive electroencephalography is not conclusive. We describe a technique for recording electroencephalographic activity via an endovascular approach. Recordings were performed with a Seeker-10 microguide.

All recordings were compared with simultaneous scalp recording. This semi-invasive method of identifying epileptogenic areas can detect the epileptiform discharges without interferences; it is useful as a complement to invasive techniques such as foramen ovale or depth recording.