Imaging funzionale per diffusione (DWI) e ischemia cerebrale in fase acuta: Potenzialità diagnostiche e confronto con metodiche convenzionali

Stroke is the third leading cause of death and is a major cause of long-term disability. Neuroprotective treatment within a 4-hour «therapeutic window» has proved highly efficacious in reducing morbility and mortality in animal model. It is with this background that the need for emergent diagnosis and therapy of acute stroke in strongly suggested. Computed tomography (CT) shows the parenchymal changes of acute stroke too late to be helpful, and its role has been primarily to evaluate the possibility of intracerebral or subarachnoid hemorrhage. While conventional magnetic resonance (MR) imaging can demonstrate parenchymal abnormalities 4–6 hours after ischemia, newer techniques such as diff…

Guillain-Barré syndrome after orthotopic liver transplantation: A clinical manifestation of immune reconstitution inflammatory syndrome?

Guillain-Barrè Syndrome, as part of the spectrum of dysimmune neuropathies, is unexpected to occur in immunocompromised hosts. We describe a clinical case of Guillain-Barrè syndrome, occurred a few weeks after a liver transplant, and we postulate that our case would satisfy all requirements to explain this peripheral nervous system complication as a clinical manifestation of an Immune reconstitution inflammatory syndrome. In this setting of liver transplantation, complicated by potentially multiple infective triggers, reduction of immunosuppression and reversal of pathogen-induced immunosuppression, through antimicrobial therapy, may have led to pro-inflammatory response. The pro-inflammato…

Retroaortic left renal vein joining the left common iliac vein

Retroaortic left renal vein joining the left common iliac vein is a rare congenital anomaly in the development of the inferior vena cava. To our knowledge, only one case has been reported in the literature; however, its imaging features have never been described. A 27-year-old male presented with a 1-year history of recurrent right flank pain, dysuria, hematuria, and fever (39 degrees C). Computed tomography and MR venography showed a retroaortic left renal vein joining the left common iliac vein. We present the CT and MR venography findings and discuss their feasibility in showing this congenital anomaly.

Brain Core Temperature of Patients Before and After Orthotopic Liver Transplantation Assessed by DWI-Thermometry

Purpose The brain produces heat as a result of cerebral metabolism, and the heat is removed mainly through circulation of the intracranial blood vessels and cerebrospinal fluid (CSF). The aim of this study was to assess the brain core temperature of adult patients with end stage liver disease before and after orthotopic liver transplantation (OLT) using a noninvasive temperature measurement technique based on the diffusion coefficient of the cerebrospinal fluid. Materials and Methods This retrospective study used the data collected from January, 2014 to January, 2017. The study group comprised 19 patients (16 men, 3 women, mean age 57.9 ± 7.4 years) with a MELD score 23.7 who underwent magn…

Valore dell'esame TC di perfusione nell'ischemia cerebrale acuta

Diagnostic performance of reformatted isotropic thin-section helical CT images in the detection of superior semicircular canal dehiscence

Purpose The purpose of this article is to assess the diagnostic performance of computed tomography (CT) reformatted images for detection of superior semicircular canal (SSC) dehiscence. Material and methods Forty-two patients, with sound- and/or pressure-induced vestibular symptoms, and 42 control participants underwent helical CT examination with a highly collimated beam (0.5 mm). Reformatted images of the vestibular labyrinth were obtained in the standard axial and coronal planes (group A images), and in a plane parallel and perpendicular to the SSC (group B images). Diagnostic performance obtained by evaluating the group A images alone and the group B images alone was analyzed by using t…

TC perfusionale nell'ischemia cerebrale acuta: Valore predittivo dei parametri di perfusione cerebrale nel discriminare il tessuto vitale da quello infartuato

Purpose. The aim of this study was to assess the value of computed tomography (CT) perfusion parameters in differentiating tissue viability in acute stoke patients. Materials and methods. Thirteen patients (mean age 63.3 years) with nonhaemorrhagic stroke underwent multidetector perfusion CT within 3 h of symptom onset. Images were continuously acquired at the basal ganglia over 40 s during injection of 90 ml of iodinated contrast medium injected at a rate of 9 ml/s with a 9-s delay. Z-axis coverage was 20 mm. All patients underwent diffusion-weighted magnetic resonance imaging (DWI) within 12 h of perfusion CT to define the extent of the infarct. Perfusion CT data were analysed in regions …

Computerised tomography and magnetic resonance imaging of laryngeal squamous cell carcinoma: A practical approach

Squamous cell carcinoma is the most common head and neck cancer. This review describes the state-of-the-art computerised tomography and magnetic resonance imaging protocols of the neck and the normal larynx anatomy, and provides a practical approach for the diagnosis and staging of laryngeal squamous cell carcinoma.

Imaging of calcified hepatic lesions: spectrum of diseases

Hepatic calcifications have been increasingly identified over the past decade due to the widespread use of high-resolution Computed Tomography (CT) imaging. Calcifications can be seen in a vast spectrum of common and uncommon diseases, from benign to malignant, including cystic lesions, solid neoplastic masses, and inflammatory focal lesions. The purpose of this paper is to present an updated review of CT imaging findings of a wide range of calcified hepatic focal lesions, which can help radiologists to narrow the differential diagnosis.

SVILUPPO DI UN SERVER DICOM A BASSO COSTO CON FINI DIDATTICI E DI RICERCA

PURPOSE: This paper describes our experience in developing a DICOM (Digital Imaging and Communications in Medicine) server based on widely available personal computers enabling to use X-ray digital images for teaching and scientific purposes. MATERIALS AND METHODS: The system is based on a DICOM server running on a widely used personal computer. The selected DICOM images are collected directly from the radiological equipment or from a dedicated 3D image processing workstation through a LAN connection and converted into one of the standard formats (JPEG or GIF) to allow their direct importing into multimedia presentations for teaching or scientific purposes. RESULTS: This system allows fast …

Optimizing Liver Division Technique for Procuring Left Lateral Segment Grafts: New Anatomical Insights.

Left liver lobe (left lateral segment) grafts (LLG) is currently the most commonly used graft to transplant children (2/3 of cases currently in Europe); it is prepared by liver division (DL) in both living (LD) and deceased donors (DD) settings. Technically speaking, classical DL is through the parenchyma of segment IV - dividing the main left glissonean pedicle left to the main biliary confluence (trans-hilar (TH) approach): historically, this technique was introduced by Bismuth and Pichlmayr in 1988 in DD setting, and applied one year later for the first successful living donor transplantations by Strong (Figure 1).

Assessment of cerebral microbleeds by susceptibility-weighted imaging at 3T in patients with end-stage organ failure

Purpose: Cerebral microbleeds (CMBs) are small rounded lesions representing cerebral hemosiderin deposits surrounded by macrophages that results from previous microhemorrhages. The aim of this study was to review the distribution of cerebral microbleeds in patients with end-stage organ failure and their association with specific end-stage organ failure risk factors. Materials and methods: Between August 2015 and June 2017, we evaluated 15 patients, 9 males, and 6 females, (mean age 65.5 years). Patients population was subdivided into three groups according to the organ failure: (a) chronic kidney failure (n = 8), (b) restrictive cardiomyopathy undergoing heart transplantation (n = 1), and (…

Imaging findings of cerebral involvement in end-stage renal failure patients on hemodialysis

Focal confluent fibrosis in cirrhotic liver: natural history studied with serial CT.

The objective of this study was to assess the long-term natural history of focal confluent fibrosis in cirrhotic liver with CT.Two radiologists retrospectively reviewed in consensus 118 liver CT examinations in 26 patients (19 men, seven women; age range, 32-68 years; mean age, 50 years) performed over approximately 6 years. Helical CT scans were obtained before and 30-35 and 65-70 seconds after injection of 125-150 mL of contrast medium at a rate of 4-5 mL/s. Proof of cirrhosis was based on liver transplantation (n = 6), biopsy (n = 9), or imaging findings (n = 11). The number, location, and attenuation of fibrotic lesions and presence of trapped vessels were evaluated. Variation of hepati…

Hamartoma of the urinary bladder: case report and review of the literature.

Bladder hamartoma is a rare benign entity with only eight cases reported in the literature thus far, and whose general imaging features have not, to our knowledge, been previously discussed. The purpose of this report is to review the literature and to discuss the imaging findings in one case of bladder hamartoma where US features were those of an inhomogeneous solid mass with an unechogenic center, which was in accordance with the CT findings of a soft tissue mass with central inhomogeneous enhancement due to central necrosis.

Magnetic resonance findings in scuba diving-related spinal cord decompression sickness

Scuba diving is associated with risk of severe decompression sickness (DCS type II), which results from rapid reduction of the environmental pressure sufficient to cause the formation into tissue or blood of inert gas bubbles previously loaded within tissues as a soluble phase. DCS type II constitutes a unique subset of ischemic insults to the central nervous system (CNS) with primarily involvement of the spinal cord. Ten patients with diving-related barotrauma underwent neurologic examination. Two of them presented progressive sensory and motor loss in the extremities at admission and were presumed affected by spinal cord DCS. Magnetic resonance imaging (MRI) demonstrated abnormalities in …

Multiple sclerosis: High prevalence of the ‘central vein’ sign in white matter lesions on susceptibility-weighted images

Purpose The aim of this study was to determine the occurrence and distribution of the ‘central vein’ sign in white matter lesions on susceptibility-weighted magnetic resonance images in patients with multiple sclerosis (MS) and cerebral small vessel disease (CSVD). Materials and methods T2-weighted and fluid-attenuated inversion recovery magnetic resonance images of 19 MS patients and 19 patients affected by CSVD were analysed for the presence and localisation of focal hyperintense white matter lesions. Lesions were subdivided into periventricular or non-periventricular (juxtacortical, subcortical, deep white matter and cerebellar) distributed. The number and localisation of lesions present…

Gastrointestinal stromal tumor (GIST): 40-row multislice computed tomography findings

Feasibility in routine clinical setting of combined resting-state fMRI and DTI-tractography for surgical planning of brain tumors

Purpose Methods and materials Results Conclusion Personal information and conflict of interest References

Initial experiences in radiology e-learning

The use of two different educator-centric learning management systems (LMSs), Moodle and Manila, for radiology e-learning was formatively evaluated and the implications of the future use of LMSs in radiology education were explored. NeuroRAD, a neuroradiologic digital library and learning community, is implemented with Moodle, one of the most popular open-source educator-centric LMSs. Pediatric-Education.org, a pediatric digital library and learning community, is implemented with Manila, a commercial educator-centric LMS. Quantitative and qualitative analyses of these LMSs were performed with World Wide Web server log file statistical programs and user-submitted comment forms. In 2005, Neur…

Perfusion MR Imaging in Differentiating High-Grade from Low-Grade Gliomas

To correlate perfusion MR imaging with histologic grade of cerebral gliomas. Materials & Methods Relative cerebral blood volume (rCBV) maps were determined in 22 patients with pathologically proved gliomas (11 glioblastomas, 8 anaplastic gliomas and 2 low-grade gliomas) by dynamic contrast-enhanced T2*-weighted MR imaging. MR examination was completed with conventional T1- and T2-weighted imaging. The rCBV maps were calculated with an independent workstation by fitting a gamma-variate function to the contrast material concentration versus time curve. Relative CBV ratios obtained between tumor and normal white matter were compared between glioblastomas, anaplastic gliomas and low-grade gliom…

Valore prognostico dell’iperdensità dell’arteria cerebrale media all’esame TC nell’ischemia cerebra

CT and MR imaging of cystic renal lesions

AbstractCystic renal lesions are a common incidental finding on routinely imaging examinations. Although a benign simple cyst is usually easy to recognize, the same is not true for complex and multifocal cystic renal lesions, whose differential diagnosis includes both neoplastic and non-neoplastic conditions. In this review, we will show a series of cases in order to provide tips to identify benign cysts and differentiate them from malignant ones.

Unusual imaging manifestation of severe bilateral cochlear otosclerosis: a case report

MR Signal Changes as Predictor of Pancreas Iron Overload and Impairment in Secondary Hemochromatosis

dc.description.abstract

Temperature Measurement by Diffusion-Weighted Imaging

Diffusion-weighted imaging (DWI) thermometry is a magnetic resonance-based imaging tool that allows the noninvasive measurement of brain core temperature. Although only applicable to cerebrospinal fluid, it is thought to be potentially useful in assessing the thermal pathophysiology of the brain in both patients and healthy subjects. The objective of this article is to provide a concise but thorough review of the basic physical principles and the principal applications of DWI thermometry as a potential method to elucidate the pathophysiology of several brain diseases and neurologic syndromes.

Assessment of cerebral microbleeds by susceptibility-weighted imaging in Alzheimer's disease patients: A neuroimaging biomarker of the disease.

Purpose The objective of this study was to correlate the presence and distribution of cerebral microbleeds in Alzheimer’s disease patients with cerebrospinal fluid biomarkers (amyloid-beta and phosphorylated tau 181 protein levels) and cognitive decline by using susceptibility-weighted imaging magnetic resonance sequences at 1.5 T. Material and methods Fifty-four consecutive Alzheimer’s disease patients underwent brain magnetic resonance imaging at 1.5 T to assess the presence and distribution of cerebral microbleeds on susceptibility-weighted imaging images. The images were analyzed in consensus by two neuroradiologists, each with at least 10 years’ experience. Dementia severity was assess…

Seizure in isolated brain cryptococcoma: Case report and review of the literature

Background: Central nervous system (CNS) cryptococcosis is an invasive fungal infection predominantly seen among immunosuppressed patients causing meningitis or meningoencephalitis. Rarely, cryptococcosis can affect immunologically competent hosts with the formation of localized CNS granulomatous reaction, known as cryptococcoma. Common symptoms of CNS cryptococcoma are headaches, consciousness or mental changes, focal deficits, and cranial nerve dysfunction. Rarely, seizures are the only presenting symptom. Case Description: We report the case of an immunocompetent patient with a solitary CNS cryptococcoma presenting with a long history of non-responsive generalized seizure who has been s…

Neurological Screening in Elderly Liver Transplantation Candidates: A Single Center Experience.

Background: Cerebral small vessels disease (cSVD) is an age-related disorder and risk factor for stroke and cognitive/motor impairments. Neurological complications (NCs) are among the causes of adverse outcomes in older liver transplant recipients. This study sought to determine whether cSVD predicts acute NCs in over 65-year-old liver transplant patients. Methods: Data were collected, from a retrospective medical chart review, of 22 deceased donor liver transplant recipients aged 65 years or older with a pre-operative brain magnetic resonance imaging (MRI). We used the Fazekas score (0–3) as a quantitative measurement of the vascular lesion load seen in the MRI. We analyzed all post-operat…

Transjugular intrahepatic portosystemic shunt (TIPS) complications: what diagnostic radiologists should know

Transjugular intrahepatic portosystemic shunt (TIPS) is an effective therapy for portal hypertension complications and can successfully treat variceal bleeding and refractory ascites. Although TIPS is relatively safe, procedural- or shunt-related morbidity can reach 20%, and procedural complications have a fatality rate of 2%. Delayed recognition and treatment of TIPS complications can lead to life-threatening clinical scenarios. Complications can vary from stent migration or malpositioning to nontarget organ injury, TIPS dysfunction, encephalopathy, or liver failure. This review aims to outline the role of diagnostic radiology in assessing post-TIPS complications.[GRAPHICS].

Tumori gastrointestinali stromali: Aspetti con tomografia computerizzata multidetettore (40-strati)

Purpose. The purpose of this study was to describe the findings and evaluate the role of multidetector (40-slice) computed tomography (MDCT) in the preoperative assessment of gastrointestinal stromal tumours (GISTs). Materials and methods. Thirteen patients with histologically proven GIST (size: 4-30 cm; mean: 9 cm) underwent 40-slice MDCT after the ingestion of 1,000 ml of water. Images were obtained before and 70 s after intravenous injection of 120 ml of iodinated contrast agent. Two experienced radiologists reviewed the CT findings to evaluate lesion site, size, margins, attenuation, growth pattern, enhancement pattern, ascites, lymphadenopathy, direct invasion to adjacent organs and di…

Sviluppo di un server DICOM a basso costo ai fini didattici e di ricerca

MRI findings and evoked potentials in patients with myotonic dystrophy versus facioscapulohumeral dystrophy

Evoked potentials recordings have been applied to many neurological disorders, localizing the lesions in the central nervous system (CNS) pathways. Facioscapulohumeral muscular dystrophy (FSHD) is a slowly progressive degenerative disease involving the muscles of the face and shoulders. On the contrary, myotonic distrophy (MD), the most frequent and severe myotonic disease, is caracterized by myotonia (delay of relaxation after voluntary contraction), muscular atrophy and dystrophic changes in non-muscular tissues. In the present investigation, patients with clinically and electromyographically verified FSHD and MD were examined using somatosensory evoked potentials (SEP) and brainstem aud…

Transfusional Hemochromatosis: Quantitative Relation of MR Imaging Pituitary Signal Intensity Reduction to Hypogonadotropic Hypogonadism

To assess the relationship between magnetic resonance (MR) imaging pituitary signal intensity reduction in patients with transfusional hemochromatosis and the clinical manifestation of hypogonadotropic hypogonadism.Pituitary MR imaging at 0.5 T was performed in 38 consecutive patients affected by secondary hemochromatosis and in 20 healthy volunteers. Serum ferritin levels were estimated in the affected population. Twenty (53%) of the 38 patients had hypogonadotropic hypogonadism diagnosed. Pituitary-to-fat signal intensity ratios were calculated from coronal gradient-echo (GRE) T2*-weighted MR images. The relationship between the quantitative reduction of the pituitary-to-fat signal intens…

RELATIONSHIP BETWEEN BRAIN ATROPHY AND NATALIZUMAB THERAPY IN THE TREATMENT OF MULTIPLE SCLEROSIS

Intraforaminal lumbosacral discal herniation. Treatment of symptomatic patients with intradiscal injection oxygen-ozone (O2-O3) mixture

Acute and reversible Pisa syndrome as unusual presentation of portosystemic encephalopathy

Abstract We present the first case of acute and reversible Pisa Syndrome, as a clinical manifestation of a portosystemic encephalopathy bout occurring in a patient affected with cirrhosis and clinical-radiological signs of acquired hepatocerebral degeneration, without exposure to psychotropic medications. A 62 year-old man suffering from cirrhosis was admitted to our hospital for sudden onset of mild confusion and postural change. He was observed walking and standing with a tilt toward the right during the last two hours. On neurological examination, he showed bilateral asterixis and extrapyramidal signs. Clinical diagnosis of Pisa Syndrome was made in a setting of raised serum ammonia. A b…

Valutazione comparativa delle sequenze fast Spin-echo e Spin-echo T2-dipendenti nella dimostrazione delle lesioni demielinizzanti encefaliche in corso di sclerosi multipla

We compared T2-weighted fast spin-echo (FSE) magnetic resonance (MR) imaging and conventional spin-echo (CSE) T2-weighted imaging in the detection of brain lesions of multiple sclerosis (MS). 20 patients with clinically definite MS underwent brain imaging with both FSE and CSE T2-weighted imaging. There was no significant difference in total number of lesions detected on FSE vs CSE (1354 vs 1378). Slightly more periventricular and subcortical lesions were detected using CSE than FSE, whereas more posterior cranial fossa lesions were detected by FSE. There was no statistically significant difference in the signal intensity (SI) ratio of MS lesions to that of surrounding normal white matter …

Assessment of brain core temperature using MR DWI-thermometry in Alzheimer disease patients compared to healthy subjects

Purpose: To assess the brain core temperature of Alzheimer disease (AD) patients in comparison with healthy volunteers using diffusion-weighted thermometry. Materials and methods: Fourteen AD patients (3 men, 11 women; age range 60–81 years, mean age 73.8 ± 6.1 years) and 14 healthy volunteers, age and sex-matched (mean age 70.1 ± 6.9 years; range 62–84 years; 5 men, 9 women) underwent MR examination between February 2014 and March 2016. MR imaging studies were performed with a 1.5-T MR scanner. Brain core temperature (T: °C) was calculated using the following equation from the diffusion coefficient (D) in the lateral ventricular (LV) cerebrospinal fluid: T = 2256.74/ln (4.39221/D) − 273.15…

Usefulness of quantitative peritumoural perfusion and proton spectroscopic magnetic resonance imaging evaluation in differentiating brain gliomas from solitary brain metastases

Objectives The purpose of our study was to evaluate whether peritumoural perfusion weighted and proton spectroscopic magnetic resonance imaging can be used in differentiating between primary gliomas and solitary metastases. Methods Ten low-grade gliomas, eight high-grade gliomas and 10 metastases were prospectively evaluated with magnetic resonance imaging, dynamic susceptibility contrast enhanced perfusion imaging and single-voxel proton magnetic resonance spectroscopy before surgical resection or stereotactic biopsy. Maximal relative cerebral blood volume values were calculated drawing three regions of interest of 2 cm2 in the non-enhancing peritumoural areas. Maximal relative cerebral bl…

Glioma Grading: The Role of Combined Perfusion MR Imaging and Single-Voxel MR Spectroscopy Compared to Conventional MR Imaging

Abstract Body: Purpose To assess the contribution of combined perfusion MR imaging (MRI) and single-voxel MR spectroscopy (MRS) in grading primary gliomas compared with conventional MRI. Materials & Methods Thirty-two patients with primary cerebral glioma underwent conventional MRI, dynamic contrast-enhanced T2*-weighted perfusion MRI and single-voxel proton MRS. Gliomas were graded as low or high based on conventional MRI. The rCBV measurements were obtained from regions of maximum perfusion normalized between tumor and healthy tissue. Metabolite ratios ( [Cho]/[Cr], [Cho]/[NAA], [NAA]/[Cr]) were measured with TE: 34 ms. Tumor grade determined with the three methods then was compared with …

Outcome of LR-3 and LR-4 observations without arterial phase hyperenhancement at Gd-EOB-DTPA-enhanced MRI follow-up

Objective: The aim of this study was to retrospectively analyze the outcome of LR-3 and LR-4 without arterial phase hyperenhancement (APHE), and identify which features could predict LR-5 progression on serial Gd-EOB-DTPA-enhanced MRI follow-up. Methods: Forty-nine cirrhotic patients with 55 LR-3 and 19 LR-4 without APHE were evaluated. Observations were classified as decreased, stable or increased in category at follow-up. Observation size and LI-RADS major and ancillary features were evaluated. Results: Seventeen/fifty-five (31%) LR-3 and 8/19 (42%) LR-4 progressed to LR-5 at follow-up. Baseline LI-RADS major and ancillary features were not significantly different among LR-3 and LR-4. A d…

Multiple sclerosis: prevalence of the ‘central vein’ sign in white matter lesions on gadolinium-enhanced susceptibility-weighted images

Aims To evaluate prospectively whether an intravenous gadolinium injection could improve the detection of the central vein sign on susceptibility-weighted imaging sequences obtained with a 1.5 T magnetic resonance scanner in patients with multiple sclerosis compared to unenhanced susceptibility-weighted images. Materials and methods This prospective, institution review board-approved study included 19 patients affected by multiple sclerosis (six men; 13 women; mean age 40.8 years, range 20–74 years). Patients had the relapsing–remitting clinical subtype in 95% of cases, and only one (5%) patient had the primary progressive clinical subtype of multiple sclerosis. T2-weighted images, fluid-at…

Imaging of hepatocellular carcinoma recurrence after liver transplantation

Abstract Liver transplantation (LT) provides the highest survival benefit to patients with unresectable hepatocellular carcinoma (HCC). The Milan criteria have been developed for the selection of LT candidates with the goal of improving survival and maintaining an acceptable risk of HCC recurrence. Despite this, recurrence of HCC after LT occurs in up to 20% of cases and represents a major concern due to the poor prognosis of these patients. Furthermore, several extended criteria for the selection of LT candidates have been proposed to account for the growing demand for organs and the resultant increase in the risk of HCC recurrence. Radiologists should be aware that HCC can recur after LT…

CONTRIBUTO DELLA RM PERFUSIONALE IN ASSOCIAZIONE ALLA SPETTROSCOPIA RM SINGLE VOXEL NELLA DEFINIZIONE DEL GRADING DEI GLIOMI CEREBRALI.

Sindrome da leuconecefalopatia posteriore reversibile (RPLS): aspetti neuroradiologici

Superior Canal Dehiscence: Multidetector-Row CT Evaluation

High-­grade gliomas and solitary metastases: differentiation by using peritumoral perfusion and proton spectroscopic MR imaging.

MR imaging of bilateral paramedian thalamic and mesencephalic infarcts: A case report

We describe MR imaging of bilateral infarction of the paramedian portion of the mesencephalus and thalamus due to an occlusion of the Percheron artery. This entity is due to one of the anatomic variants of the perforating arteries supplying the thalamus and mesenchephalus. Clinically this kind of infarction presents with neurologic impairment as a disorder of consciousness, memory dysfunctions, various types of vertical gaze palsy and psychic changes, which need to be differentiated from delirium and coma. At MRI evaluation infarction of the paramedian portion of thalami and midbrain, with a “butterfly wings” pattern, was demonstrated as high signal intensity areas on FLAIR and FSE-T2W ima…

Brain-core temperature of patients before and after orthotopic liver transplantation assessed by DWI thermometry

To assess brain-core temperature of end-stage liver disease patients undergoing orthotopic liver transplantation (OLT) using a temperature measurement technique based on the apparent diffusion coefficient of the cerebrospinal fluid in the lateral ventricles. The study group was composed of 19 patients with a model for end-stage liver disease (MELD) score of 23.7 who underwent MR imaging before and after OLT. MR imaging studies were performed with a 1.5T MR scanner. Brain-core temperature (T: °C) was calculated using the following equation from the apparent diffusion coefficient (D) of the cerebrospinal fluid in the lateral ventricles: $$T = {{2256.74} \mathord{\left/ {\vphantom {{2256.74} {…

The value of serial MR imaging in the assessment of brain metastases volume control during stereotactic radiosurgery

Purpose: To evaluate early tumour control capabilities of Stereotactic Radiosurgery (SRS) in the treatment of brain metastasis and the role of follow-up MR imaging. Methods and Materials: MR imaging of 54 metastases in 31 patients treated with SRS who underwent follow-up MR imaging within 12 months were retrospectively reviewed. Tumours were characterized as either enlarged (>20% volume increase), stable (follow-up volume ±20% of the initial volume), or decreased (> 0% volume decrease). Results: Within the first 6 weeks following SRS a decrease was observed in 25 (52%) of the tumours in the extent of 63% in size. Tumour reduction varied according to histopathological subtype with 38% of non…

PROGRESSIVE MULTIFOCAL LEUCOENCEPHALOPATHY DURING TACROLIMUS THERAPY FOR LIVER TRANSPLANTATION

Resting-State Functional Connectome in Patients with Brain Tumors Before and After Surgical Resection

Purpose: High-grade glioma surgery has evolved around the principal belief that a safe maximal tumor resection improves symptoms, quality of life, and survival. Mapping brain function has been recently improved by resting-state functional magnetic resonance imaging (rest-fMRI), a novel imaging technique that explores networks connectivity at “rest.” Methods: This prospective study analyzed 10 patients with high-grade glioma in whom rest-fMRI connectivity was assessed both in single-subject and in group analysis before and after surgery. Seed-based functional connectivity analysis was performed with CONN toolbox. Network identification focused on 8 major functional connectivity networks. A v…

Ruolo dell'esame RM dell'encefalo nella gestione di pazienti affetti da talassodrepanocitosi in trattamento con idrossiurea

Chemionucleolisi dell’ernia lombosacrale con miscela Ozono-Ossigeno (O2-O3) con tecnica periradicolare e periganglionare: ruolo della TC

Brain damage in hanging: A new CT finding

We report a 23-year-old man who attempted suicide by hanging. There have been few reports of involvement of the brain parenchyma shown on CT, all showing ischaemic lesions. This is the first report of multifocal intracerebral haematomas due to hanging seen on CT.

Hippocampal and Amygdalar Volumes Changes in Drug Addicts: A Preliminary Study

Oral comunication for American Society of Neuroradiology 45th Annual Meeting. Chicago, June 9-14 2007

Development of an OpenSource eLearning Radiology System

Magnetic resonance imaging of the pituitary gland in patients with secondary hypogonadism due to transfusional hemochromatosis

To identify pituitary iron overload in patients with transfusional hemochromatosis causing secondary hypogonadism, we prospectively evaluated signal intensity abnormalities of the anterior lobe of the pituitary gland of 18 patients affected by transfusion-dependent thalassemia major and secondary hypogonadism. Magnetic resonance (MR) imaging is useful to assess pituitary iron overload in patients with transfusional hemochromatosis and secondary hypogonadism by detection of a significant decreased signal intensity of the anterior lobe of the pituitary gland on GRE T2*-weighted images. The decreased signal intensity of the anterior lobe of the pituitary gland on GRE T2*-weighted images was co…

Evolution of indeterminate hepatocellular nodules at Gd-EOB-DPTA-enhanced MRI in cirrhotic patients

To retrospectively analyze the evolution of indeterminate hepatocellular nodules in cirrhotic patients on serial Gd-EOB-DPTA-enhanced MRI, and to identify predictors of HCC development. This IRB approved study included 33 cirrhotic patients with 69 indeterminate hepatocellular nodules (mean diameter 1.1 cm) at baseline Gd-EOB-DPTA-enhanced MRI and a Gd-EOB-DPTA-enhanced-MRI follow-up of at least 2 years. Two radiologists evaluated size and signal intensity of each nodule at baseline and follow-up. Age, cirrhosis etiology, and HCC history were recorded. Data were compared between nodules that became HCCs at follow-up (HCC) and those that did not (no-HCC). On follow-up, 5/69 nodules became HC…

Role of non-coding RNAs in age-related vascular cognitive impairment: An overview on diagnostic/prognostic value in Vascular Dementia and Vascular Parkinsonism

Age is the pivotal risk factor for different common medical conditions such as cardiovascular diseases, cancer and dementia. Among age-related disorders, cardiovascular and cerebrovascular diseases, represent the leading causes of premature mortality strictly related to vascular ageing, a pathological condition characterized by endothelial dysfunction, atherosclerosis, hypertension, heart disease and stroke. These features negatively impact on the brain, owing to altered cerebral blood flow, neurovascular coupling and impaired endothelial permeability leading to cerebrovascular diseases (CVDs) as Vascular Dementia (VD) and Parkinsonism (VP). It is an increasing opinion that neurodegenerativ…

Ernia midollare transdurale toracica idiopatica: aspetti RM

Left kidney mass in a 45 year old woman

Resting-State Functional Magnetic Resonance Imaging for Surgical Neuro-Oncology Planning: Towards a Standardization in Clinical Settings

Resting-state functional magnetic resonance imaging (rest-f-MRI) is a neuroimaging technique that has demonstrated its potential in providing new insights into brain physiology. rest-f-MRI can provide useful information in pre-surgical mapping aimed to balancing long-term survival by maximizing the extent of resection of brain neoplasms, while preserving the patient’s functional connectivity. Rest-fMRI may replace or can be complementary to task-driven fMRI (t-fMRI), particularly in patients unable to cooperate with the task paradigm, such as children or sedated, paretic, aphasic patients. Although rest-fMRI is still under standardization, this technique has been demonstrated to be feasible…

Assessment of Functional Connectome in End-Stage Organ Disease Patients After Life-Threatening Surgery

Purpose The purpose of this study was to assess the organization of intrinsic functional brain networks (functional connectome) in neurologically asymptomatic patients with end-stage organ disease who had undergone major surgery for life-threating conditions and compare it to a control group. Materials and Methods Resting-state functional magnetic resonance imaging (rest-fMRI) was performed in 10 adult, post-operative patients with end-stage organ disease. The patients (7 men, 3 women, mean age 57.9 ± 7.4 years) had undergone: n=4 coronary artery bypass graft for heart failure, n=2 orthotopic liver transplantation for non-alcoholic cirrhotic liver failure, n=3 mitral valve repair for heart …

Dynamic CT Perfusion in Acute Stroke: Predictive Value of MTT in Assessing Tissue Viability versus Infarction

Resting-State Functional Magnetic Resonance Imaging for Brain Tumor Surgical Planning: Feasibility in Clinical Setting.

The aim of this study was to introduce resting-state functional magnetic resonance imaging (rest-fMRI) capability for brain tumor surgical planning. rest-fMRI is an emerging functional neuroimaging technique potentially able to provide new insights into brain physiology and to provide useful information regarding brain tumors in preoperative and postoperative settings. rest-fMRI evaluates low-frequency fluctuations in the blood oxygen level–dependent signal while the subject is at rest during magnetic resonance imaging examination. Multiple resting-state networks have been identified, including the somatosensory, language, and visual networks, which are of primary importance for surgical pl…

Sopravvivenza a 3 anni dei linfomi non Hodgkin aggressivi trattati con chemioterapia associata a radioterapia involved field (IF-RT).

Ranula complicata: descrizione di un caso studiato con risonanza magnetica

[Detection of extra-articular soft-tissue involvement in rheumatoid arthritis: value of color-coded Doppler sonography]

Sviluppo di un server intranet per la didattica in ambito radiologico

LONG-TERM NATURAL HISTORY OF FOCAL CONFLUENT FIBROSIS (FCF) IN THE CIRRHOTIC LIVER: A CT SERIAL ANALYSIS

MR imaging technique for the diagnosis of pituitary iron overload in patients with transfusion-dependent beta-thalassemia major

To identify the optimal MR imaging technique for diagnosing pituitary iron overload, we compared spin-echo and gradient-echo MR imaging with measurements of pituitary T2 relaxation times in 30 patients with secondary hemochromatosis due to transfusion-dependent beta-thalassemia major and in 10 healthy volunteers. We found that the optimal MR imaging technique to evaluate pituitary iron overload is the gradient-echo T2*-weighted technique, as it best demonstrated signal reduction in the anterior lobe of the pituitary gland.

MR imaging of pancreatic changes in patients with transfusion-dependent beta-thalassemia major.

The aim of this study was to evaluate MR imaging changes of the pancreas in patients with transfusion-dependent beta-thalassemia major.Twenty patients with transfusion-dependent beta-thalassemia major were examined using MR imaging at 0.5 T, with spin-echo T1-weighted, fast spin-echo T2-weighted, and gradient-echo T2*-weighted sequences. Image analysis was performed to assess pancreas-to-fat signal intensity ratios for all pulse sequences. Pancreatic exocrine and endocrine function and serum ferritin levels were assessed. Twenty healthy volunteers underwent MR imaging with the same three sequences and served as a control group.The pancreas-to-fat signal intensity ratio was significantly dec…

Accuracy of SWI sequences compared to T2*-weighted gradient echo sequences in the detection of cerebral cavernous malformations in the familial form

Purpose The purpose of this study was to assess the accuracy of susceptibility-weighted imaging (SWI), compared with T2*-weighted gradient echo (GRE) imaging in assessing cerebral cavernous malformations. Materials and methods We retrospectively evaluated 21 patients with a familial form of cavernous malformation. Magnetic resonance (MR) protocol included non-enhanced and contrast-enhanced fast-spin echo (FSE) T1-weighted sequences, FSE T2-weighted sequences, fluid-attenuated inversion-recovery (FLAIR), GRE T2*-weighted and SWI sequences. Images were reviewed in consensus by two expert neuroradiologists to assess the location, number, size and conspicuity of the lesions on T2*-weighted GRE …

The long-term natural history of focal confluent fibrosis in cirrhotic liver: a CT serial analysis.

Diffusion tensor imaging in amyotrphic lateral sclerosis: quantitative assesment ot the corticospinal tract degeneration.

Poster for European Society of NeuroRadiology. Genoa, 20-23 September 2007

La RM nelle urgenze: encefalo

ASSESSMENT OF BRAIN METASTASES VOLUME CONTROL DURING STEREOTACTIC RADIOSURGERY BY LONGITUDINAL REGION GROWTH MR IMAGE SEGMENTATION ANALYSIS

Reversible MRI abnormalities in an unusual paediatric presentation of Wernicke's encephalopathy

Background. We report an unusual paediatric presentation of acute Wernicke's encephalopathy in a 12-year-old boy affected by chronic gastrointestinal disease. MRI demonstrated, in addition to the typical diencephalic and mesencephalic signal abnormalities on T2-weighted images, enhancement of the mammillary bodies and the floor of the hypothalamus. Materials and methods. Following parenteral administration of thiamine for 4 days, the patient recovered from his neurological deficits and on follow-up enhanced MRI 1 month later, no signal abnormalities were found nor was there diencephalic or mesencephalic atrophy, as is usual in the chronic phase of the disease. Results. MRI provides crucial …

Imaging processing for CT angiography of the cervicocranial arteries: evaluation of reformatting technique.

Purpose. The aim of this study was to compare computed tomography angiography (CTA) sliding-thin-slab (STS) multiplanar reformatting (MPR), STS maximum intensity projection (MIP) and three-dimensional (3D) volume rendering (VR) reformatting techniques in the evaluation of cervicocranial arteries. Materials and methods. Twenty patients examined with multislice CT were included in this study. CTA images were reformatted as STS-MIP, STS-MPR and 3DVR in orthogonal planes and in the oblique-coronal plane. Images were evaluated in consensus by two radiologists, with a third radiologist to resolve discordances in grading image quality parameters. The Spearman correlation analysis was performed to …

Brain magnetic resonance imaging radiomics features associated with hepatic encephalopathy in adult cirrhotic patients.

Abstract Purpose Hepatic encephalopathy (HE) is a potential complication of cirrhosis. Magnetic resonance imaging (MRI) may demonstrate hyperintense T1 signal in the globi pallidi. The purpose of this study was to evaluate the performance of MRI-based radiomic features for diagnosing and grading chronic HE in adult patients affected by cirrhosis. Methods Adult patients with and without cirrhosis underwent brain MRI with identical imaging protocol on a 3T scanner. Patients without history of chronic liver disease were the control population. HE grading was based on underlying liver disease, severity of clinical manifestation, and number of encephalopathic episodes. Texture analysis was perfo…

Advanced magnetic resonance imaging of cortical laminar necrosis in patients with stroke

Purpose The aim of this study was to assess the novel advanced magnetic resonance imaging findings of acute stage cortical laminar necrosis developing after complicated cardiovascular or abdominal surgery. Materials and methods This institutional review board-approved study included patients with postoperative stroke due to cortical laminar necrosis imaged with magnetic resonance in the acute stage. Brain magnetic resonance imaging examinations were obtained on a 3T magnetic resonance scanner within 48 hours of the neurological symptoms, including diffusion-weighted images (b value, 1000 s/mm2) and arterial spin labelling using a pseudo-continuous arterial spin labelling method in four pati…

Accumulo di ferro a livello ipofisario in pazienti affetti da beta-talassemia major: Aspetti RM

Gli autori si propongono di valutare le modificazioni del segnale RM a livello ipofisario nella emosiderosi secondaria in pazienti affetti da beta-talassemia major. Lo studio è stato condotto prospetticamente su un gruppo di 20 pazienti in regime alto-trasfusionale e trattamento ferro-chelante e su 10 volontari sani come gruppo di controllo. Gli esami RM sono stati condotti con apparecchiatura a magnete superconduttivo a 0,5T con sequenze SE TI-dipendenti e GRE TE*-dipendenti. Il sovraccarico di ferro è stato valutato mediante il dosaggio della ferritina sierica. è stata effettuata una valutazione quantitativa delle immagini RM SE T1- e GRE T2*-dipendenti attraverso la misurazione, mediant…

Hypogonadotrophic Pituitary Insufficiency in Transfusional Hemochromatosis Complicating Thalassemia Major: MR Imaging

To identify pituitary iron overload in patients with transfusion-dependent thalassemia major causing secondary hypogonadism, we prospectively evaluated signal intensity abnormalities of the anterior lobe of the pituitary gland of 30 patients comparing spin-echo, gradient-echo imaging and pituitary T2 relaxation times measurement. We found that pituitary iron overload can best be assessed by MR imaging using gradient-echo T2*-weighted technique to establish signal reduction in the anterior lobe of the pituitary gland. This finding is correlated to increasing serum ferritin level — a parameter that reflects the severity of iron overload, and is more evident in patients with secondary hypogon…

Comparison of Single-Echo T2-weighted Fast Spin-Echo and Conventional Spin-Echo MR Sequences

We compared single-echo T2-weighted fast spin-echo (FSE) magnetic resonance imaging and conventional spin-echo (CSE) T2-weighted imaging in the detection of brain lesions of multiple sclerosis (MS). 16 patients with clinically definite MS underwent brain imaging at 0.5 T with T2-weighted single-echo fast spin-echo (FSE) and conventional spin-echo (CSE) sequences. Image analysis was performed by three of the investigators who worked together to reduce interobserver variability. Statistical analysis was performed using Student's t test to assess the difference in the contrast-to-noise (C/N) ratio of MS lesions between CSE and FSE sequences. The Wilcoxon signed rank test was used to evaluate …

Value of serial magnetic resonance imaging in the assessment of brain metastases volume control during stereotactic radiosurgery

AIM To evaluate brain metastases volume control capabilities of stereotactic radiosurgery (SRS) through serial magnetic resonance (MR) imaging follow-up. METHODS MR examinations of 54 brain metastases in 31 patients before and after SRS were reviewed. Patients were included in this study if they had a pre-treatment MR examination and serial follow-up MR examinations at 6 wk, 9 wk, 12 wk, and 12 mo after SRS. The metastasis volume change was categorized at each follow-up as increased (> 20% of the initial volume), stable (± 20% of the initial volume) or decreased (< 20% of the initial volume). RESULTS A local tumor control with a significant (P < 0.05) volume decrease was observed in 25 meta…

E-learning in radiologia

Computed tomography of bowel obstruction: Tricks of the trade

Bowel obstruction (BO) is a frequent cause of hospitalization and surgical consultation for acute abdominal pain. It is usually suspected at physical examination, but clinical and laboratory data are often nonspecific. Thus, computed tomography plays a crucial role in a correct diagnosis of BO. Indeed, computed tomography can confirm a diagnosis of BO, and identify the location and cause of the obstruction. In this review, the computed tomography appearances of common and uncommon causes of BO and pseudo-obstruction are reviewed.

Radioterapia esclusiva a confronto con la radioterapia associata alla Temozolomide (TMZ) nei gliomi cerebrali high grade.

Lumbosacral disc herniation: Spinal interventional chemonucleolysis with oxygen-ozone (O2-O3) mixture with periradicular and periganglionic technique (Role of CT)

Valore dell’esame TC di perfusione nell’ischemia cereb

Lumbosacral disc herniation: spinal interventional chemonucleolysis with CT intradiscal oxygen-ozone (O2-O3) mixture

Magnetic resonance imaging in the assessment of brain involvement in alcoholic and nonalcoholic Wernicke's encephalopathy

AIM To present the typical and atypical magnetic resonance (MR) imaging findings of alcoholic and non-alcoholic Wernicke’s encephalopathy. METHODS This study included 7 patients with Wernicke’s encephalopathy (2 men, 5 women; mean age, 52.3 years) that underwent brain MR examination between January 2012 and March 2016 in a single institution. Three patients were alcoholics and 4 patients were non-alcoholics. MR protocol included a T2-weighted sequence, a fluid attenuation inversion recovery (FLAIR) sequence, a diffusion-weighted sequence (b = 0 and 1000 s/mm2), and a contrast-enhanced MR sequence. All MR images were retrospectively reviewed at baseline and follow-up by two radiologists. RES…

A rare case of ruptured aneurysm of the paramedian artery of Percheron.

Introduction The artery of Percheron is a rare anatomic variant supplying bilateral medial thalamic nuclei and a variable portion of the rostral part of midbrain. Case report A 48-year-old female with massive subarachnoid hemorrhage due to a ruptured aneurysm of the paramedian artery of Percheron presented to the emergency room. Because of significant risk of recurrent intracranial hemorrhage, it was decided to proceed with endovascular embolization of the aneurysm. The patient was ultimately sent to a rehabilitation center and her presenting neurologic deficits showed significant improvements in the weeks following endovascular embolization treatment. Discussion The paramedian artery of Pe…

Development of a Radiology Collaborative Web Server

Ruolo dell’ecografia transcranica con pulse inversion ed ecoamplificatore nel follow-up delle MAV cerebrali sottoposte a trattamento non chirurgico

Grading dei gliomi cerebrali: ruolo combinato degli studi RM di perfusione e di spettroscopia a confronto con lo studio in tecnica RM convenzionale

Poster per il 26° Congresso Nazionale Associazione Italiana di Neuroradiologia Diagnostica e Interventistica

Bolus-test VS bolus-tracking nello studio angio-TC dei vasi epiaortici e del circolo intracranico.

Poster congresso nazionale SIRM. Verona, 11- 15 giugno 2010.

E-learning e teleradiologia: nostra esperienza con OsiriX e iChat.

Poster congresso nazionale SIRM. Verona, 11-15 giugno

Angio-RM a confronto con angiografia digitale nella diagnosi degli aneurismi cerebrali.

Poster congresso nazionale AINR. Bergamo, 20-23 Giugno 2007

Imaging con trattografia nella pianificazione chirurgica delle neoplasie cerebrali: esperienza preliminare.

Poster congresso nazionale AINR. Bergamo, 20-23 Giugno 2007

Imaging del tensore di diffusione nella SLA: esperienza preliminare nella valutazione della degenerazione dei FCS.

Comunicazione orale per il Congresso nazionale SIRM. Roma, 23-27 maggio 2008

Computed assisted radiology (CAR) nello studio della patologia vascolare aneurismatica e malformativa atero-venosa del circolo intracranico: nostra esperienza con QuickTime VR ed OsiriX.

Poster congresso nazionale SIRM. Verona, 11- 15 giugno 2010.

Massiva emorragia intratumorale causa di atipica presentazione clinica di un neurinoma cistico del cui: caratteristiche TC ed RM e analisi morfovolumetrica.

Poster per congresso nazionale AINR. Padova, 19-22 Ottobre 2011