Trans-cranial Magnetic Resonance-guided Focused UltraSound (tcMRgFUS) system integrated with a 1.5T: an SNR study on DQA phantoms

Background: In recent years transcranial Magnetic Resonance-guided Focused Ultrasound Surgery (tcMRgFUS) treatments have been performed only using 3T units. Since following some internal analysis, planning images obtained using a 1.5T MRI’s body RF coil (as usually done with 3T systems) showed generally reasonable quality in terms of anatomy visualization and SNR but thermal images noise was above acceptable standard for treatments, a dedicated 2-channels head coil was developed (InSightec Ltd.) to ensure an adequate signal-to-noise ratio (SNR). Hence, we present the imaging protocol and the technological methods successfully used with the world-first installation of a certified tcMRgFUS sy…

THALAMIC PARCELLATION FOR TARGET IDENTIFICATION INTRANS-CRANIAL MR-GUIDED FOCUSED ULTRASOUND (TCMRGFUS)THALAMOTOMIES: A PRELIMINARY PROBABILISTC TRACTOGRAPHYSTUDY

Presacral Myelolipoma

Many reports have described adrenal myelolipomas but there have been only a few reports of extra-adrenal myelolipomas. We describe a 74-year-old woman who came to our observa- tion for MRI of the lumbar spine for typical lumbar back pain. In addition to signs of mild scoliosis and spondylo disc arthrosis, MR imaging revealed a presacral mass showing a heterogeneously high signal in all pulse sequences and almost completely suppressed on inversion recovery sequences for fat tissue. CT imaging confirmed the fatty nature of the lesion and no signs of bone involvement. These findings were most consistent with a diagnosis of a rare presacral myelolipoma as confirmed at histopathologic analysis. …

POSTOPERATIVE COMPLICATIONS,PAIN AND QUALITY OF LIFE AFTER THORACOSCOPIC OF THOREACOTOMIC LOBECTOMY FOR LUNG CANCER

Aim: Thoracoscopic lobectomy is superior to thoracotomy, but the evidence for this assumption is low. We present a comparison between thoracotomy and thoracoscopy in term of postoperative complications, mortality, postoperative, hospital stay and quaklity of life. Patients and methods: This is a rectrospective analysis of 224 lobectomies in 24-months. 128 patients (57.1%) were operated by thoracotomy; 96 patients (42.9%) by videothoracoscopy. Results: Major complications were observed in 4/128 (3.1%) in thoracotomy group and in 1/96 (16.7%) thoracoscopy. Thoracoscopy patients had a shorter hospital stay. Conclusion: our study shows an advantage of thorascopy over thoracotomy but furher stud…

Thalamic parcellation for target identification in trans-cranial MR-guided Focused UltraSound (tcMRgFUS) thalamotomies: a preliminary probabilistc tractography study

Background: Trans-cranial MR-guided Focused UltraSound (tcMRgFUS) allows a neurofunctional exploration of thalamic nuclei to confirm and optimize the target before inducing a permanent brain lesion. However, the choice of the target is based on stereotactic coordinates that do not take into account the anatomical variability of each single patient. Thus, the optimization of the treatment target is based on the patient's feedback during lower power sonications. The aim of this work is to retrospectively evaluate the possible role of thalamic parcellation for the identification of the intermediate ventral nucleus (VIM) in patients undergoing tcMRgFUS. Materials and Methods: A 1.5T MR scanner …

TRANS-FUSIMO: Preliminary in-vivo animal results of MR-guided Focused Ultrasound of liver under respiratory motion

Background: Treating liver tumors using FUS poses a great challenge due to the respiratory motion of the target and by the rib cage obscuring the anatomical location of the malignancy. In the EU FP7 project TRANS-FUSIMO (www.trans-fusimo.eu) a novel treatment software has been developed to support MR guided focused ultrasound treatment of liver lesions through electronic real-time beam steering of the ultrasound transducer. Prior to clinical use we conduct an in-vivo animal trial using the TRANS-FUSIMO treatment system (TTS) to evaluate the safety and the technical efficacy and efficiency of generation predefined necrotic lesions in the healthy liver. Material and Methods: The pre-clinical …

FUNCTIONAL CONNECTIVITY OF THE CEREBELLUM INPATHOLOGICAL GAMBLER

Transcranial Magnetic Resonance-guided Focused Ultrasound Surgery (tcMRgFUS) at 1.5T: this is how we do it

Aims and objectives Methods and materials Results Conclusion Personal information References

L’iperreattività bronchiale e la BPCO nel paziente anziano

NEURODEGENERATION IN MULTIPLE SCLEROSIS: COMPARISON BETWEEN CLINICAL, NEUROPSYCHOLOGICAL, MRI,AND OPTICAL COHERENCE TOMOGRAPHY PARAMETERS

BACKGROUND AND OBJECTIVE Optical Coherence Tomography (OCT) enables rapid, non-invasive in vivo measurement of retinal nerve fiber layer (RNFL) thickness, reflecting axonal density within the optic nerve. There is still lack of concordance about the use of OCT in clinical routine as a surrogate measure of brain atrophy. Objective: To investigate the role of OCT as possible predictor of disability, cognitive impairment and neurodegeneration in Multiple Sclerosis (MS). MATERIAL AND METHODS We recruited patients affected by MS according to validated criteria at the Neurological Department of the University of Palermo. Patients performed Stratus OCT- 3 Zeiss to assess RNFL and GCS measurements.…

TRANS-FUSIMO – A novel system for treatment support for FUS applications in moving abdominal organs

Computer based treatemnt support for FUS therapy of moviving abdominal organs is essential due to great intrinsic challenges: the target moves due to breathing and may be occluded by the rib cage. In the EU project TRANS-FUSIMO we have developed a sophisticated software system that connects to a FUS transducer and an MRI. This enables physicians to conduct safe, effective and efficient ablation of tumors in the moving liver.

MRgFUS results Italy

PURPOSE: To present our preliminary results achieved with the first Italian installation of a trans-cranial MRI-guided Focused Ultrasound Surgery (tcMRgFUS) certified system for functional neurosurgery. Moreover, to our knowledge, this is the world-first tcMRgFUS system ever installed on a 1.5T MRI unit. Technical issues faced to achieve a safe and effective treatment will be discussed focusing on MR high-resolution live imaging and thermometry sequences optimization. METHOD AND MATERIALS: Patient enrollment was based on indication for functional neurosurgery and evidence of medication-refractory disease; a detailed medical history has been collected together with a complete clinical examin…

Resection of a giant mediastinal leiomyosarcoma

ABSTRACT Primary leiomyosarcomas of the lung are rare tumors. We report a case of 49-year-old female with history of cough, breathless at rest, right sided chest pain. Chest CT showed a huge (16 cm) mediastinal mass located on the right mediastinum encasing the right main pulmonary artery and infiltrating the main right bronchus and pericardium. The tumor was resected with combined pericardiectomy and pnemonectomy via hemiclamshell incision. This surgical access provided an adequate exposure of the chest “blind zones” and it allowed a radical and safe surgical resection of lung, pleura, pericardium and diaphragm. The final diagnosis showed a low grade differentiation leiomyosarcoma.

Trans-cranial MRI-guided Focused Ultrasound Surgery (tcMRgFUS): preliminary Italian (and world-first) experience at 1,5 Tesla.

PURPOSE: We present our preliminary results achieved with the first Italian installation of a trans-cranial MRI-guided Focused Ultrasound Surgery (tcMRgFUS) certified system for functional neurosurgery. Moreover, to our knowledge, this is the world-first tcMRgFUS system ever installed on a 1.5T MRI unit. Technical issues faced to achieve a safe and effective treatment will be discussed focusing on MR high-resolution live imaging and thermometry sequences optimization. METHOD AND MATERIALS: Patient enrollment was based on indication for functional neurosurgery and evidence of medication-refractory disease; a detailed medical history has been collected together with a complete clinical examin…

Voxel-Based Morphomerty study in patients with amnestic Mild Cognitive Impairment and Alzheimer's Disease: population-based data from the Zabùt Aging Project

Aims and objectives Methods and materials Results Conclusion Personal information References

LIPOCORISTOMA DELL’ANGOLO PONTO-CEREBELLARE: UN NUOVO NOME PER UNA VECCHIA CONOSCENZA

SCOPO DEL LAVORO: I lipochoristomi sono rari tumori benigni (0.1% di tutti i processi espansivi dell’angolo ponto-cerebellare) che in passato si riteneva derivassero dalle cellule della primitiva meninge e pertanto venivano definiti come lipomi dell’angolo ponto-cerebellare (o del condotto uditivo interno). Oggigiorno sono più propriamente definiti come "coristomi lipomatosi" (o lipocoristomi) poiché si è dimostrato che originano dal tessuto mesenchimale proprio del nervo vestibolo-cocleare. Scopo del presente lavoro è quello di presentare dei casi di lipocoristoma alla luce dei dati oggi riportati nella più recente letteratura. MATERIALI E METODI: Saranno presentati casi di pazienti con ri…

Resting state functional magnetic resonance imaging analysis of the brain of pathological gamblers

Purpose . Gambling disorder has been recently reclassified under the category ‘‘substance-related and addictive disorders”. Recent studies performed through functional MRI (fMRI) have shown that the perseverance of some behaviors can alter brain activation [1,2]. In this work we aim at investigating functional connectivity changes in pathological gamblers (PGs) in comparison to healthy controls (HCs) by means of resting state functional Magnetic Resonance Imaging (rs-fMRI). Methods and materials. Thirteen HCs and fourteen PGs were recruited (all right handed males; drugs free; mean age 36 ± 10 yrs). All acquisitions were performed through a 1,5 T MRI scanner using a 8-channels phased-array …

MAGNETIC RESONANCE IMAGING–GUIDED FOCUSED ULTRASOUND THALAMOTOMY IN PATIENT WITH TREMOR COMBINED WITH PARKINSONISM: RETREATMENT AFTER BENEFIT DECAY

Background In recent years, transcranial Magnetic Resonance-guided Focused UltraSounds (tcMRgFUS) treatments for functional neurological disorders are giving a new thrust to the field of therapeutic brain lesioning. This technique has been proven safe and effective in selected patients. Here we present the case of a patient affected by tremor combined with parkinsonism who underwent a second tcMRgFUS thalamotomy because of relapsing tremor after a few months from the first tcMRgFUS treatment. Materials and Methods A 72-year-old, right-handed man, who came to our observation because of a disabling tremor affecting mainly his upper right limb and refusing any invasive surgical procedure. His …

ROUTINARY USE OF FIBRIN SEALANTS TO PREVENT PROLONGED AIR LEAK IN THORACIC SURGERT: OUR EXPERIENCE

Introduction: prolonged air leak (PAL) is one of the most common postoperative complications after lung surgery. It is associatred with increased significant morbidity, lower quality of life, longer hospital stay and higher hospital costs. Since its great clinical and economic burden, it is important to establish the feasibility and the effectiveness of the routinary preventive use of a fibrin sealant in order to reduce the incidence of prolonged air leaks. Patients and methods: this is a randomized study on 189 adult patients - 118 men (62,4%) and 71 women (37,6%) aged from 39 to 87 y.o. (mean age 68,3 y.o.) - who underwent lung surgery (lobectomy or bilobectomy) with intraoperatory detect…

ORAL MICROBIOTA: CHARACTERISTICS, RELATED PATHOLOGIES AND FUTURE PROSPECTS

The oral microbiota is represented by the set of bacteria and microrganisms that reside in the oral cavity. It is formed from bird and stabilizes during the period of permanent dentition. The oral microbiota poresents from 500 to 700 bacterial species, belonging to six main phyla, Firmicutes, Bacteroidetes, Proteobacteria, Actinobacteria, Spirochaetes and Fusobacteria. These bacteria partecipate in the formation of dental plaque, a sort of biofilm that deposits on the rigid surfaces of the oral cavity, and contributes to the healthy maintenance of the oral cavity. An alteration of the oral microbiota contributes to the pathogenesis of periodontitis, caries, gingivitis and also of systemic d…