Neuronavigation-guided biopsy for differential diagnosis of pseudotumoral demyelinating brain lesions

Abstract Marburg's disease (MD) is an extremely rare and aggressive form of multiple sclerosis (MS). In some cases, MD presents with tumefactive demyelinating lesions with a “tumor-like” appearance in MRI images, for which it may be difficult to achieve a form of differential diagnosis between definitive tumors or abscesses. Here we report a case of MD histopathologically confirmed after neuronavigationguided biopsy. Postoperative course was uneventful and following discharge, the patient attended outpatient follow-up appointments and received i.v. cyclophopsphamide, achieving progressive clinical remission. A nine-month follow-up brain MRI scan with gadolinium showed no signs of progressin…

Renal endometriosis mimicking complicated cysts of kidney: report of two cases

Endometriosis is a common gynecologic disorder characterized by ectopic endometrial tissue growth outside the uterine cavity. Although usually occurring in pelvic organs, endometrial lesions may involve urinary tract. Renal endometriosis is extremely rare and it has only occasionally been reported in the past. We report two cases of patients with renal cystic lesions, incidentally found at imaging techniques during oncologic follow-up for gastric sarcoma and melanoma, initially misinterpreted as complicated haemorrhagic cysts and then histologically characterized as renal localizations of extragenital endometriosis.

Imaging of inner ear malformations: a primer for radiologists

AbstractIn the multidisciplinary management of patients with inner ear malformations (IEMs), the correct diagnosis makes the differences in terms of clinical and surgical treatment. The complex anatomical landscape of the inner ear, comprising several small structures, makes imaging of this region particularly challenging for general radiologists. Imaging techniques are important for identifying the presence and defining the type of IEM and the cochlear nerve condition. High-resolution magnetic resonance imaging (MRI) sequences and high-resolution computed tomography (HRCT) are the mainstay imaging techniques in this area. Dedicated MRI and HRCT protocols play an important role in the diagn…

TRANS-CRANIAL MRI-GUIDED FOCUSED ULTRASOUND SURGERY (TCMRGFUS): PRELIMINARY ITALIAN (AND WORLD-FIRST) EXPERIENCE AT 1,5 TESLA (first 3 cases treated)

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. TcMRgFUS is a promising new technology for the non-invasive treatment of neurologic disorders such as Essential Tremor (ET), tremor dominant idiopathic Parkinson's Disease (PD) and Neuropathic Pain (NP). This is a new method for focal targeting and lesioning of specific regions in the brain through intact skull by using high intensity focused ultrasound beam to achieve thermal ablation and …

Resting state fMRI as a tool to investigate brain functional connectivity

Long-lasting coma.

n this report, we describe the case of a patient who has remained in a comatose state for more than one year after a traumatic and hypoxic brain injury. This state, which we refer to as long-lasting coma (LLC), may be a disorder of consciousness with significantly different features from those of conventional coma, the vegeta- tive state, or brain death. On the basis of clinical, neu- rophysiological and neuroimaging data, we hypothe- size that a multilevel involvement of the ascending reticular activating system is required in LLC. This description may be useful for the identification of other patients suffering from this severe disorder of con- sciousness, which raises important ethical i…

CEUS LI-RADS: a pictorial review

AbstractContrast-enhanced ultrasound (CEUS) greatly improved the diagnostic accuracy of US in the detection and characterization of focal liver lesions (FLLs), and it is suggested and often included in many international guidelines as an important diagnostic tool in the imaging work-up of cirrhotic patients at risk for developing hepatocellular carcinoma (HCC). In particular, CEUS Liver Imaging Reporting and Data System (LI-RADS) provides standardized terminology, interpretation, and reporting for the diagnosis of HCC. The aim of this pictorial essay is to illustrate CEUS features of nodules discovered at US in cirrhotic liver according to LI-RADS categorization.

Diffusion and sensitivity characteristics of a chemically cross-linked PVA-Fricke gel dosimeter

Introduction: Current radiotherapy techniques implement treatment plans based on volumetric distributions of dose with complex shapes and sharp gradients. The agreement between these plans and the dose that is truly delivered is very challenging to verify. Thus, there is the need for a dosimetric system that is truly three dimensional, sensitive to radiation in each point and tissue equivalent. In this framework, great interest is encountered by radio-chromic gel dosimeters. In order to address the limitations of gels based on natural matrices, some investigators have proposed dosimeters based on poly vinyl alcohol (PVA) made by freezing-thawing cycles. Even though these gels have a low dif…

Is there still a role for lesioning in functional neurosurgery? Preliminary Italian (and world-first) experience with a trans-cranial MRI-guided focused ultrasound surgery system operating at 1.5 Tesla

Is Transcranial Magnetic Resonance Imaging-Guided Focused Ultrasound a Repeatable Treatment Option? Case Report of a Retreated Patient With Tremor Combined With Parkinsonism

Introduction In recent years, transcranial Magnetic Resonance Imaging-guided Focused Ultrasound (tcMRgFUS) treatments for functional neurological disorders are giving a new thrust to the field of therapeutic brain lesioning. Objective To 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. Methods A 72-yr-old, right-handed man, came to our observation because of a disabling tremor affecting his upper limbs, refusing any invasive surgical procedure and already treated by tcMRgFUS left Vim thalamotomy. However, clinical benefit had brief duration…

Ultrasound in peripheral nerve injuries: the challenge. Response

Letter to the Editor Regarding "Cystoventricular Drainage of Intracranial Arachnoid Cysts in Adults".

Trauma cranico nello sport

Reward networks changes in the brain of pathological gamblers: a resting state functional magnetic resonance imaging study

Aims and objectives Methods and materials Results Conclusion Personal information References

Lacrimal glands herniation in patients with Graves’ Ophthalmopathy: an effective MRI-derived marker of disease activity

Aims and objectives Methods and materials Results Conclusion Personal information References

PVA gel dosimeters for radiotherapy applications,

Gel dosimeters for three-dimensional mapping of radiotherapy doses were introduced at Yale University in the mid-1980’s. Soon after, research and development in this field also started in Italy. Early work was done at the Istituto Superiore di Sanità, and at the Universities of Pisa and Milan. Several institutes now collaborate on this topic with the goal of developing new formulations of hydrogel matrices with improved characteristics of stability, sensitivity and spatial resolution compared to those of earlier Fricke-gel and polymer-gel systems. Contrary to earlier gels based on natural gelling agents, such as porcine skin gelatin and/or agarose, which suffer from limited batch -to-batch …

PATHOLOGICAL GAMBLING: AN ASSOCIATION WITH ALEXITHYMIA, PERSONALITY DISORDERS AND CLINICAL SYNDROMES

Pathological gambling (PG) is a disorder recently conceptualized as a behavioural addiction, because of its neurobiological, neurophysiological and psychological features (American Psychiatric Association. Diagnostic and statistical manual of mental disorders - 5th ed., 2013; Potenza et al., 2012). PG represents both a social and a sanitary cost, in terms of pharmacological and psychological therapies. The aim of this study was to examine the correlation between personality disorders, clinical syndromes and alexithymia levels in a group of pathological gamblers. Furthermore this study aimed at highlighting a relationship between PG and alexithymia, over and above the relationship between pe…

LE SEQUENZE T2-FLAIR E DWI NELLA DIAGNOSI DI ENCEFALOPATIA DI WERNICKE NON ALCOOL- CORRELATA

SCOPO DEL LAVORO Valutare l’accuratezza delle immagini T2-FLAIR e DWI nello studio delle lesioni caratteristiche dell’Encefalopatia di Wernicke. MATERIALI E METODI Studio effettuato su donna di 56 anni, affetta da Encefalopatia di Wernicke non alcool-correlata. Nel Dicembre 2011 la paziente è stata sottoposta ad esame RM, utilizzando un tomografo operante a 1,5 T con acquisizione di scansioni sui piani assiale, sagittale e coronale in tecnica Spin-Echo (SE), Fast Spin-Echo (FSE), Fluid Attenuated Inversion Recovery (FLAIR) e Diffusion Weighted Imaging (DWI), con sequenze T1 e T2 pesate. L’esame è stato completato dopo infusione e.v. di m.d.c. paramagnetico. L’indagine mostrava la presenza…

Resting state FMRI: A tool to investigate functional connectivity modulation induced by transcranial direct current stimulation of the motor network

Introduction: Resting-state functional connectivity (fcMRI) represents a novel fMRI approach that allows detection of temporal correlations in spontaneous BOLD signal oscillations while subjects rest quietly in the scanner. Under resting conditions the brain is engaged in spontaneous activity that causes a low frequencies (<0.1 Hz) BOLD signal fluctuations. Functional connectivity (FC) can be defined as the synchrony of neural activity among spatially distant regions. Transcranial direct current stimulation (tDCS) is a non-invasive brain stimulation technique that is known to modulate cortical activity and FC among brain regions, as measured by functional magnetic resonance imaging. This st…

Riproducibilità intraindividuale del FEV6 in soggetti anziani

Is there still a role for lesioning in functional neurosurgery: the Italian experience of delivering focused ultrasound high energy through a 1,5 tesla MR apparatus.

Advanced techniques in Magnetic Resonance Imaging: characterization of non-gaussian water diffusion using DIFFUSION KURTOSIS IMAGING (DKI)

SEMEIOTICA NEURORADIOLOGICA E POSSIBILI DIAGNOSI DIFFERENZIALI DI UN RARO CASO DI MIELOLIPOMA PRESACRALE

SCOPO Presentiamo il caso di una paziente anziana (74aa) con tipica sintomatologia da artrosi e discopatia lombo-sacrale (rigidità e dolore alla regione lombare con tipica irradiazione ai glutei ed alla superficie posteriore di entrambi gli arti inferiori, con associata sensazione di intorpidimento) e segni di radicolopatia L4-L5-S1 all’esame obiettivo neurologico, che si presenta alla nostra attenzione per eseguire un esame RM del rachide lombo-sacrale. MATERIALI E METODI L’esame RM è stato eseguito in condizioni di base con sequenze TSE-T1, TSE-T2 e STIR-T2 secondo piani sagittali ed assiali (GE Signa HDxt 1,5T). E’ stata inoltre effettuata un’integrazione RM dopo somministrazione di md…

Diffusion Kurtosis Imaging: prime applicazioni cliniche in ambito neuroradiologico

A CASE OF A PRESACRAL MYELOLIPOMA: IMAGING FINDINGS AND DIFFERENTIAL DIAGNOSIS CHECKLIST OF OTHER PRESACRAL MASSES

PURPOSE: There have been many reports describing adrenal myelolipoma but there have been only few reports of extraadrenal myelolipoma. We describe a case of an elderly woman with lower back pain due to age-related spondyloarthrosis and mild discopathy with a presacral myelolipoma as incidental finding. We also discuss about common and uncommon imaging findings of other presacral masses. METHODS: A 74 years-old woman came to our observation to perform an MRI of the lumbar spine for typical lumbar back pain. MR imaging revealed, in addition to the signs of mild scoliosis and spondylo-disc-arthrosis, a presacral mass showing heterogeneously high signal in all sequences and almost completely su…

Clinical and Brain Imaging Findings in a Child with Vitamin B12 Deficiency

Vitamin B12 (Vit-B12) deficiency is a rare and treatable cause of failure to thrive and delayed development in infants who are exclusively breastfed. Apart from genetic causes, it can be related to a malabsorption syndrome or when the mother follows a strict vegetarian or vegan diet, causing a low hepatic storage of Vit-B12 in the infant at birth. As the neurological symptoms are nonspecific, a brain magnetic resonance imaging (MRI) exam is usually performed to rule out primary causes of neurodevelopmental delay. Findings related to brain atrophy are usually observed. A favorable response is achieved with Vit-B12 therapy, and neurological symptoms dramatically improve within a few days afte…

Functional connectivity modulation induced by transcranial direct current stimulation of the motor network investigated by resting state fMRI

This study is aimed at measuring the variation of functional connectivity between cortical brain regions after tDCS along time. For this purpose we enrolled 20 healthy right-handed subjects.

MALATTIA DI ERDHEIM–CHESTER: RARE LOCALIZZAZIONI SPLANCNO- ED INTRA-CRANICHE IN PAZIENTE CON STADIO AVANZATO DI MALATTIA

SCOPO DEL LAVORO Presentiamo il caso di una donna di 63 anni con storia di pseudotumor orbitae e diagnosi tardiva di Malattia di Erdheim-Chester (MEC) con coinvolgimento multisistemico e rare localizzazioni a livello splancno- ed intracranico. MATERIALI E METODI La paziente, a causa della comparsa di astenia progressivamente ingravescente, vomito e disfagia per i solidi veniva condotta al PS dove eseguiva ECG ed esami ematochimici e veniva ricoverata con la diagnosi di disidratazione e squilibrio elettrolitico. L’esame obiettivo evidenziava pallore e disidratazione di cute e mucose, ipotrofia muscolare e proptosi bulbare bilaterale da pseudotumor orbitario infiammatorio cronico con evidenti…

Hippocampal reversible lesions in a case of transient global amnesia

We report the case of 55-year-old man that after an emotional stress showed retrograde and anterograde amnesia with impairment of orientation in space and time but undisturbed consciousness. A neurological examination excluded other neurological signs or symptoms. The amnesic syndrome resolved spontaneously within 24 hours and the hypothesis of transient global amnesia was placed. Brain CT scan and conventional MRI sequences did not show any relevant pathological findings but diffusion-weighted imaging (DWI) showed two millimetric bright spot of restricted diffusion in the right hippocampus; in a brain MRI follow-up those findings were no more appreciable. The diagnosis of transient global …

Correlation between ferrous ammonium sulfate concentration, sensitivity and stability of Fricke gel dosimeters exposed to clinical X-ray beams

Abstract This work describes the characterization of various Fricke-Agarose-Xylenol gels (FXG) dosimeters using NMR relaxometry and MRI analysis. Using X-rays from a clinical linear accelerator (LINAC), the gels were irradiated in the dose range from 0 Gy to 20 Gy. The photon sensitivity of the FXGs was measured in terms of NMR relaxation rates; its dependence on radiation dose was determined as a function of ferrous ammonium sulfate contents (from 0.5 mM to 5 mM). Furthermore, the stability of the NMR signal was monitored over several days after irradiation. These measurements were aided by Magnetic Resonance Imaging (MRI) scans which allowed three-dimensional (3D) dose mapping. In order t…

PERFORMANCE OF DIFFUSION KURTOSIS IMAGING FOR CHARACTERIZATION OF PROSTATE LESIONS USING 1.5T MAGNETIC RESONANCE IMAGING SCANNER

The aim of the study is to evaluate the diagnostic performance of apparent diffusion coefficient (ADC) and apparent kurtosis coefficient (Kapp) for the characterization of prostate lesions on 1.5T MRI. This retrospective study included 34 patients with at least one lesion with PI-RADS score≥ 3. Performances of ADC and Kapp were evaluated using the Mann-Whitney U test and receiver operating characteristics curve (AUROC). Lesions with Gleason score≥6 had significantly lower Kapp compared to benign lesions (p=0.025). The ADC-ratio was the only significantly different parameter between GS≥7 and GS=6 lesions (p=0.039). Kapp showed the largest AUROC for the diagnosis of GS≥6 prostate cancers (AUR…

Encefalopatia ipertensiva cronica (EIC): sensibilità delle sequenze GE-T2* a confronto con le SWI nell'identificazione dei micro-sanguinamenti

L'EIC è caratterizzata dalla presenza di lesioni parenchimali irreversibili, risultato di una lunga esposizione a regimi pressori patologici specie in pazienti che non seguono o non rispondono alle comuni terapie mediche. Si riscontrano quali reperti tipici multipli esiti gliotici, leucoaraiosi e multiple lesioni lacunari con predilezione per le localizzazioni profonde ai nuclei lenticolari, ai talami e al ponte. Più raramente possono evidenziarsi minuti foci emorragici parenchimali, più frequentemente localizzati nei gangli della base ma anche nel ponte e nel cervelletto, che in alcuni casi possono rappresentare la manifestazione principale della patologia: questi microsanguinamenti, vi…

Radiographic Features with Pathological Correlation in Cerebral Amyloid Inflammatory Vasculopathy A Case Report

Cerebral Amyloid Angiopathy (CAA) is characterized by deposit of β-amyloid protein in the cortical and leptomeningeal arteries. It tends to increase in prevalence with advancing age and seems to have slight predilection for temporal, parietal and occipital lobes. It has recently been identified an inflammatory form of this angiophaty. This report describes a case presenting as an inflammatory vasculitis-perivasculitis form successfully treated with steroids and discuss about typical features and findings of this condition.

Microchimerism in multiple sclerosis: The association between sex of offspring and MRI features in women with multiple sclerosis

AimsDuring pregnancy, fetal cells can migrate to the mother via blood circulation. A percentage of these cells survive in maternal tissues for decades generating a population of fetal microchimeric cells (fMCs), whose biological role is unclear. The aim of this study was to investigate the association between the sex of offspring, an indirect marker of fMCs, and magnetic resonance imaging (MRI) features in women with multiple sclerosis (MS).MethodsWe recruited 26 nulliparous MS patients (NPp), 20 patients with at least one male son (XYp), and 8 patients with only daughters (XXp). Each patient underwent brain MR scan to acquire 3D-T2w FLAIR FatSat and 3D-T1w FSPGR/TFE. Lesion Segmentation To…

Gel di Fricke: studio della risposta NMR in funzione della concentrazione di ferro ed utilizzo dosimetrico in ambito clinico (3D MRI)

Nuclear Magnetic Resonance investigation of PVA-GTA FRicke gel dosimeters exposed to clinical photon beams

Fricke Xylenol Gel (FXG) dosimetric system is based on the radiation induced oxidation of ferrous (Fe2+) to ferric (Fe3+) ions. The application of Fricke gels for ionizing radiation dosimetry is continuously increasing worldwide due to their many favorable properties. However, one of their shortcomings is that ferrous and ferric ions diffuse in the gel matrix. To maintain the spatial integrity of the dose distribution, Fricke gels must be undergoing measurement within a few hours of their irradiation, so that ferric ions remain close to their point of production. Thus, the spatial integrity of the dose distribution in the Fricke gel is maintained. The gel matrix also contributes to the oxid…

Transcranial Magnetic Resonance-Guided Focused Ultrasound Surgery for Brain Tumor Ablation: Are We Ready for This Challenging Treatment?

The treatment of high-grade gliomas (HGGs) remains a challenge for modern therapy. The prognosis for these patients has been poor. The median patient survival after diagnosis has been ∼1 year with surgery and/or radiotherapy and temozolomide.1 The need for a histological diagnosis of tumor tissue in each case and the importance of decompression in symptomatic patients are well established, and extensive surgical resection has been shown to significantly prolong survival. Several factors play a role in the prognosis of patients with HGG, including age, performance status using the Karnofsky performance scale, and the extent of resection.2, 3 At present, the standard therapy for HHG consists …

Characterization of Fricke gel dosimeters exposed to gamma rays and neutrons

New frontiers in liver ultrasound: From mono to multi parametricity

Modern liver ultrasonography (US) has become a "one-stop shop " able to provide not only anatomic and morphologic but also functional information about vascularity, stiffness and other various liver tissue properties. Modern US techniques allow a quantitative assessment of various liver diseases. US scanning is no more limited to the visualized plane, but three-dimensional, volumetric acquisition and consequent post-processing are also possible. Further, US scan can be consistently merged and visualized in real time with Computed Tomography and Magnetic Resonance Imaging examinations. Effective and safe microbubble-based contrast agents allow a real time, dynamic study of contrast kinetic f…

Post-operative computed tomography imaging evaluation of ascending aorta surgery

Ascending thoracic aorta disease is often a life-threatening condition. Aortic aneurysm and aortic dissection are the most frequent ascending aorta diseases requiring surgical intervention. Surgical repair techniques of the ascending aorta are various; they include reconstruction of the ascending aorta by using a graft with or without a prosthetic valve, reconstruction with a composite artificial graft or using a biological graft, and reconstruction of the ascending aorta with a composite graft preserving the native valve and arch repair. The radiologist plays a key role in the identification of post-operative complications; differentiation from normal postoperative findings is fundamental.…

Sensibilità e stabilità dei dosimetri gel di tipo Fricke esposti ai fotoni nel range clinico in funzione della concentrazione di ferro e degli additivi presenti: 3D MRI per applicazioni dosimetriche

COMPARATIVE EVALUATION OF DATA PREPROCESSING SOFTWARE TOOLS TO INCREASE EFFICIENCY AND ACCURACY IN DIFFUSION KURTOSIS IMAGING

Introduction: Diffusion tensor imaging (DTI) is the most commonly used technique to extract microstructural features from a set of diffusionweighted images. In addition to the metrics obtained with DTI, diffusion kurtosis imaging (DKI) can provide non-Gaussian diffusion measures by means of the kurtosis tensor. DKI has shown to be more sensitive to tissue microstructural changes in both normal and pathological neural tissue. In a clinical setting, however, these benefits are often nullified by numerous acquisition artifacts. The aim of this study was compare two preprocessing software for DTI apply to DKI. Also, the major preprocessing, processing and post-processing procedures applied to D…

MRgFUS Uterine Fibroids treatments in Sicily: Preliminary Results and comparison of a Semi-Automatic and manual contouring

Background: Traditional surgery for uterine fibroids treatments (e.g. myomectomy, hysterectomy) offers very invasive therapeutic approaches, which not always preserve reproductive potential of the woman. MRgFUS (MR guided Focused UltraSound) is a new and non-invasive technique for uterine fibroids treatment, not requiring hospitalization and recovery time [1]. On June 2011 and July 2012 the first treatments were started at HSR-Giglio Hospital in Cefalù and at University Hospital (DIBIMEF) in Palermo. An initial assessment of MRgFUS treatment was made by computing the thermally-ablated volume of uterine fibroid. This volume was evaluated considering the NPV (Non Perfused Volume) on a post-t…

Neuronavigated-biopsy in the diagniosis of demyelinating pseudotumoral brain lesions. Case report.

Introduction: Pseudotumoral-demyelinating lesions are typically characterized by severe difficulties in differential diagnosis from gliomas, metastatic tumors and abscesses. Marburg’s disease (MD) is an extremely rare and aggressive form of Mutiple Sclerosis (MS) with acute onset, rapid neurological deterioration, and poor prognosis. MRI images often show pseudotumoral lesions characterized by mild and focal or, sometimes, ring enhancement. Perhaps, radiological aspect can vary, making necessary hystopathological confirmation. Objectives: There is increasing interest in the role of surgical biopsy for a correct and early diagnosis of pseudotumoral demyelinating lesions. We report an histopa…

Interventistica eco-guidata per l’articolazione d’anca

Lo scopo di questo lavoro è di rivedere le principali applicazioni della interventistica eco-guidata d’anca, descrivendone le indicazioni e la metodologia. L’ecografia è una metodica considerata sicura per i pazienti, in quanto non è stato dimostrato un possibile danno dovuto all’energia trasmessa dagli ultrasuoni ai tessuti del paziente, contrariamente alle metodiche che fanno uso di radiazioni ionizzanti, come la radiografia convenzionale e la tomografia computerizzata. Inoltre, l’ecografia risulta rapida ed efficace nel guidare l’ago verso la sede voluta evitando di intercettare strutture vascolari e/o nervose, consentendo quindi una maggiore sicurezza, rispetto alle tecniche interventis…

Magnetic Resonance Imaging-Guided Focused Ultrasound Surgery for the Treatment of Symptomatic Uterine Fibroids

Uterine fibroids, the most common benign tumor in women of childbearing age, may cause symptoms including pelvic pain, menorrhagia, dysmenorrhea, pressure, urinary symptoms, and infertility. Various approaches are available to treat symptomatic uterine fibroids. Magnetic Resonance-guided Focused Ultrasound Surgery (MRgFUS) represents a recently introduced noninvasive safe and effective technique that can be performed without general anesthesia, in an outpatient setting. We review the principles of MRgFUS, describing patient selection criteria for the treatments performed at our center and we present a series of five selected patients with symptomatic uterine fibroids treated with this not y…

Congenital pulmonary airway malformation in adult: report of two rare cases and literature review

Congenital pulmonary airway malformations (CPAMs) are a heterogeneous group of congenital, non-hereditary lesions of the lung, cystic and non-cystic type with clear developmental anomalies and evident malformative changes, which derive from the excessive proliferation of the tubular bronchial structures. We described two rare cases of type IV CPAM detected in adult patients with different clinical presentation: one of these cases was symptomatic, complaining of cough and hemoptysis. Conversely, the other case was reported as incidental findings in patient with abdominal pain without respiratory symptoms. Chest computed tomography (CT) scan was performed showing voluminous cystic formations …

Oropharyngeal Hairy Polyp: A Case of Respiratory Failure in a Newborn

Hairy polyps, also known as dermoid polyps (DPs), are rare benign cystic lesions of bigerminal origin that may occur in several head and neck regions, including the oropharynx. Despite their benign histopathological nature, DPs may be life threatening, due to their upper airway location, and DPs represent one of the most unusual causes of respiratory distress during the neonatal period. In this paper, we describe a case of respiratory failure in a newborn with an oropharyngeal mass that was accidentally found during difficult intubation. Magnetic resonance imaging (MRI) detected a well-defined soft tissue pedunculated mass, arising from the left oropharynx wall, consistent with an oropharyn…

Chirurgia trans-cranica mediante ultrasuoni focalizzati ad alta intensità su guida RM: esperienza preliminare a 1,5T

Da qualche anno la chirurgia mediante ultrasuoni focalizzati ad alta intensità guidati da Risonanza Magnetica (Magnetic Resonance guided Focused Ultrasound Surgery, MRgFUS) si sta diffondendo anche in Italia per la palliazione del dolore da metastasi ossee, per il trattamento di tumori ossei primitivi (benigni e non), dei fibromi e dell’adenomiosi uterina; sono già stati inoltre pubblicati i risultati preliminari del trattamento di alcuni tumori epatici, pancreatici, prostatici e della mammella mediante MRgFUS. Questa innovativa tecnica prevede l’utilizzo di un’apparecchiatura di Risonanza Magnetica per il monitoraggio della procedura e sfrutta le caratteristiche fisico- meccaniche degli …

Introducing 1,5 T MRgFUS

MRgFUS is a new noninvasive thermal ablation method, consisting of a high focused ultrasound beam and a MR scanner for imaging and real-time thermal mapping. For decades, therapeutic transcranial ultrasound (tcMRgFUS) was assumed impossible. Novel technology using high-power phased array transducers and multiple channel driving electronics enabled a sharp focal point in the planned target through the intact skull allowing the use of this innovative technology for functional neurosurgery. Preliminary results have been published with systems operating with 3T MR units on patients with neurologic disorders such as essential tremor, tremor dominant idiopathic Parkinson's disease and neuropathic…

INTRACRANICAL HEMANGIOPERICYTOMA: CASE REPORT AND REVIEW OF LITERATURE

PURPOSE: We present a case of intracranical hemangiopericytoma (HPC) in a patient with migraine (male, 49 years old), who also presented mental confusion and partial left sensorimotor syndrome. We will also provide some elements regarding the international classification of this rare and highly vascularized mesenchymal tumor, and will consider possible differential diagnosis with other more common extra-axial masses. METHODS: After a preliminary examination in ER, patient underwent to head CT examination and was then transferred to the neurosurgical unit. The day after a brain MR examination was performed using advanced techniques too (PWI, and MRS); before surgery also functional MR imagin…

LESIONI REVERSIBILI DELL’IPPOCAMPO IN UN CASO DI AMNESIA GLOBALE TRANSITORIA

SCOPO DEL LAVORO: Lo scopo di questo lavoro è documentare un caso di Amnesia Globale Transitoria (Transient Global Amnesia, TGA) in un paziente emicranico di sesso maschile di 52 anni con anamnesi negativa per epilessia, disturbi psichiatrici, traumi ed abusi di sostanze. Saranno inoltre effettuati dei cenni sull’epidemiologia e i meccanismi fisiopatologici oggi più accreditati nella letteratura scientifica più recente di questa controversa sindrome neurologica. MATERIALI E METODI: Poco dopo un forte stress emotivo il paziente non ricordava cosa avesse fatto durante il giorno e ripeteva incessantemente le stesse domande a cui erano comunque state date più volte delle risposte dai colleg…

Intratumoral Haemorrhage Causing an Unusual Clinical Presentation of a Vestibular Schwannoma

We present a case of an elderly woman with no history of audiological disease with sudden onset of visual and hearing deficits associated with systemic clinical signs. On examination she had impairment of right CNs from V to X. CT and MR imaging demonstrated a cystic vestibular schwannoma with a rare intralesional fluid-fluid level correlated to a recent bleed. We include high quality MR images to show the acute impairment of the cranial nerves next to the tumour after acute bleeding. Our case report includes a voxel-based morphometry (VMB) analysis of the tumour that, as far as we know, has never been done before for such a tumour. VBM analysis was performed to calculate the hypothesized …

NUCLEAR MAGNETIC RESONANCE RELAXOMETRY AND IMAGING FOR DOSIMETRY WITH AGAROSE FRICKE GEL

Introduction: Fricke Xylenol Gel (FXG) dosimetric system is based on the radiation induced oxidation of ferrous to ferric ions. In this kind of gels it can occur that ferrous and ferric ions diffuse in the gel matrix. To preserve the spatial distribution of the dose from diffusion, Fricke gels must be undergoing measurement within a few hours of their irradiation. Thus, the spatial integrity of the dose distribution in the Fricke gel is maintained. The oxidation of ferrous ions also causes a reduction of the longitudinal nuclear magnetic relaxation time which can be measured by means of nuclear magnetic resonance (NMR) instrumentation. In this work we performed NMR relaxometry and MR imagin…

OC.03.2 THE PRESENCE OF WHITE MATTER LESIONS IS ASSOCIATED WITH THE HISTOLOGICAL SEVERITY OF NON-ALCOHOLIC FATTY LIVER DISEASE

CARATTERISTICHE NEURORADIOLOGICHE DI UN CASO DI SCLEROSI TUBEROSA DIAGNOSTICATO IN ETÀ ADULTA

SCOPO DEL LAVORO: presentiamo un caso di Sclerosi Tuberosa (Tuberous sclerosis complex, TSC; anche nota come Sindrome di Bourneville-Pringle) diagnosticato tardivamente grazie al sospetto posto dalle indagini neuroradiologiche eseguite in una paziente di 40 anni con in anamnesi ritardo mentale, crisi epilettiche e disturbi del visus.MATERIALI E METODI: la paziente si presenza alla nostra attenzione per un episodio di disorientamento e confusione mentale; dopo una prima valutazione in PS veniva eseguita una TC dell’encefalo in tecnica sequenziale (Siemens SOMATON AS+, 128 strati) e trasferita presso l’U.O.C. di Neurologia. In seguito, per una migliore caratterizzazione dei reperti descritti …

S-Detect characterization of focal breast lesions according to the US BI RADS lexicon: a pictorial essay

High-resolution ultrasonography (US) is a valuable tool in breast imaging. Nevertheless, US is an operator-dependent technique: to overcome this issue, the American College of Radiology (ACR) has developed the breast imaging-reporting and data system (BI-RADS) US lexicon. Despite this effort, the variability in the assessment of focal breast lesions (FBLs) with the use of BI-RADS US lexicon is still an issue. Within this framework, evidence shows that computer-aided image analysis may be effective in improving the radiologist’s assessment of FBLs. In particular, S-Detect is a newly developed image-analytic computer program that provides assistance in morphologic analysis of FBLs seen on US …

Radiomics and Prostate MRI: Current Role and Future Applications

Multiparametric prostate magnetic resonance imaging (mpMRI) is widely used as a triage test for men at a risk of prostate cancer. However, the traditional role of mpMRI was confined to prostate cancer staging. Radiomics is the quantitative extraction and analysis of minable data from medical images; it is emerging as a promising tool to detect and categorize prostate lesions. In this paper we review the role of radiomics applied to prostate mpMRI in detection and localization of prostate cancer, prediction of Gleason score and PI-RADS classification, prediction of extracapsular extension and of biochemical recurrence. We also provide a future perspective of artificial intelligence (machine …

Magnetic Resonance guided Focused Ultrasound Surgery (MRgFUS) for uterine fibroids: our experience on patients’ eligibility

Learning objectives Background Findings and procedure details Conclusion Personal information References

Correlati delle alterazioni della composizione corporea in pazienti anziani con BPCO

Clinical Onset and Multiple Sclerosis Relapse after SARS-CoV-2 Infection

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has been associated with several neurological disorders including headache, facial palsy, encephalitis, stroke, demyelinating disorders. The present report will discuss cases of multiple sclerosis (MS) onset and relapse both beginning early after SARS-CoV-2 infection. In both cases, magnetic resonance imaging (MRI) showed widespread bilateral subcortical and periventricular active lesions. Serum IgG against SARS-CoV-2 Spike antigens confirmed seroconversion with titers that are considered not definitely protective against possible reinfection. We hypothesize that SARS-CoV-2 infection, as previously reported for other vir…

Challenges and advances for the treatment of renal cancer patients with brain metastases: From immunological background to upcoming clinical evidence on immune-checkpoint inhibitors

The introduction of checkpoint inhibitors (ICIs) in renal cell carcinoma (RCC) treatment landscape, resulted in improvements in overall survival (OS) in metastatic patients. Brain metastases (BMs) are a specific metastatic site of interest representing a predictive factor of poor prognosis. Patients with BMs were usually excluded from prospective clinical trials in the past. Despite recent evidence suggest the efficacy and safety of ICIs, the BMs treatment remains a challenge; the immunotherapy responsiveness seems to be multifactorial and dependent on several factors, such as the genetic intratumor heterogeneity and the immunosuppressive role of the brain tumor microenvironment. This revie…

Transcranial magnetic resonance imaging-guided focused ultrasound treatment at 1.5 T: a retrospective study on treatment and patient-related parameters obtained from 52 Procedures

Objective: To present a retrospective analysis of patient- and sonication-related parameters of a group of patients treated with a transcranial magnetic resonance imaging (MRI)-guided focused ultrasound (tcMRgFUS) system integrated with a 1.5-T MRI unit. Methods: The data obtained from 59 patients, who underwent the tcMRgFUS procedure from January 2015 to April 2019, were retrospectively reviewed for this study. The following data, among others, were mainly collected: skull density ratio (SDR), skull area (SA), number of available transducer elements (Tx), and estimated focal power at target (FP). For each of the four different treatment stages, we calculated the number of sonication proces…

Preoperative imaging findings in patients undergoing transcranial magnetic resonance imaging-guided focused ultrasound thalamotomy

AbstractThe prevalence and impact of imaging findings detected during screening procedures in patients undergoing transcranial MR-guided Focused Ultrasound (tcMRgFUS) thalamotomy for functional neurological disorders has not been assessed yet. This study included 90 patients who fully completed clinical and neuroradiological screenings for tcMRgFUS in a single-center. The presence and location of preoperative imaging findings that could impact the treatment were recorded and classified in three different groups according to their relevance for the eligibility and treatment planning. Furthermore, tcMRgFUS treatments were reviewed to evaluate the number of transducer elements turned off after…

Non-alcoholic Wernicke's encephalopathy: From MRI findings of a case to differential diagnosis checklist

Wernicke's encephalopathy is a serious neurological disorder secondary to thiamine deficiency in alcoholics. However, rarely it affects non-alcoholics. Here we present a case of Wernicke's encephalopathy in a non-alcoholic 56-year-old female, treated by endoscopic surgery for a duodenal ulcer two years before. She came to our attention for a sudden onset of a neurological syndrome characterized by visual deficits, diplopia, confusion, spatial disorientation and loss of short-term memory. An MRI scan showed the typical MRI findings of Wernicke's encephalopathy, which are discussed together with the possible differential diagnosis.

Nuclear magnetic resonance relaxometry and imaging for dosimetry with agarose Fricke gel

Studio preliminare di parcellizzazione talamica per l’identificazione del target di trattamento applicato alle talamotomie trans-craniche mediante ultrasuoni focalizzati guidati da Risonanza Magnetica (tcMRgFUS) [Thalamic parcelization for target identification in trans-cranial MR-guided Focused UltraSound (tcMRgFUS) thalamotomies: a preliminary study]

Introduzione La tcMRgFUS consente di effettuare una vera e propria esplorazione neurofunzionale per confermare ed ottimizzare il target lesionale prima di indurre una lesione cerebrale permanete. La scelta del target di trattamento si basa tuttavia su coordinate stereotassiche che non tengono conto delle diversità anatomiche di ciascun individuo. L'ottimizzazione del target di trattamento viene effettuata sulla base del feedback del paziente durante la procedura stessa. Materiali e metodi È’ stato utilizzato uno scanner RM da 1.5T per acquisire sequenze morfologiche 3D e ultrastrutturali (DTI) in pazienti successivamente sottoposti a tcMRgFUS. È stata effettuata una segmentazione delle aree…

Chirurgia trans-cranica mediante ultrasuoni focalizzati ad alta intensità su guida rm: esperienza preliminare a 1,5T (primi 2 casi trattati)

Scopo del Lavoro Presentiamo i risultati preliminari ottenuti con la prima istallazione italiana di un’apparecchiatura per la neurochirurgia funzionale mediante ultrasuoni focalizzati ad alta intensità su guida RM (trans-cranial MRI-guided Focused Ultrasound Surgery, tcMRgFUS); si tratta tra l’altro della prima apparecchiatura tcMRgFUS al mondo mai installata su uno scanner RM da 1,5T. Tale apparecchiatura è attualmente certificata (CE ed FDA) per trattamenti di neurochirurgia funzionale in pazienti con tremore essenziale (Essential Tremor, ET), Parkinson idiopatico (Parkinson Disease, PD) unilaterale prevalentemente tremorigeno e dolore neuropatico (Neuropathic Pain, NP). Materiali e Metod…

INCIDENTAL ULTRASOUND FINDINGS IN A GREAT POPULATION OF SUBFERTILE PATIENTS: OUR EXPERIENCE AND DESCRIPTION OF A PARADOXICAL ONCOLOGICAL DISEASE

IκB kinase-driven nuclear factor-κB activation in patients with asthma and chronic obstructive pulmonary disease.

Background Nuclear factor-κB (NF-κB) is a transcriptional factor of different inflammatory patterns involved in asthma and chronic obstructive pulmonary disease (COPD) that is tightly controlled by IκB kinase (IKK) complex. Objective We investigated the dysregulation of IKK-driven NF-κB activation in patients with asthma and COPD. Methods We assessed IKKα and IKKβ expression and activation, their regulation by glucocorticosteroids, and their involvement in IL-8 synthesis in PBMCs isolated from asthmatic patients, healthy smokers (HSs), patients with COPD, and control subjects. PBMCs from control subjects were stimulated with TNF-α and cigarette smoke extract in the presence or absence of fl…

Ultrasound-guided intervention for hip joint

The purpose of this work is to review the main applications of ultrasound-guided hip interventional procedures, describing the indications and methodology. Ultrasound is a method considered safe for patients, as it has not been shown a possible damage due to ultrasound energy transmitted towards the patient’s tissues, as opposed to methods that make use of ionizing radiation, such as conventional radiography and computed tomography. In addition, ultra- sound is quick and effective in guiding the needle to the desired location avoiding vascular and/or nerve structures, thus enabling greater security, compared to the techniques performed in interventional fluoroscopy, which also have the disa…

Transcranial magnetic resonance-guided focused ultrasound surgery at 1.5T: a technical note.

Magnetic resonance-guided focused ultrasound is one of the emerging non-invasive technologies offering both image guidance and thermal monitoring. In recent years transcranial application of this technology is starting to impact heavily the neuroscience field. We present here the imaging protocol and the technological methods successfully used with a transcranial magnetic resonance-guided focused ultrasound system certified for clinical treatments of functional neurological disorders, integrated for the first time with a 1.5T magnetic resonance scanner. Compared to the body radiofrequency coil (the one commonly used with transcranial magnetic resonance-guided focused ultrasound system integ…

MRI Characterization of non-Gaussian water diffusion in the brain using Diffusion Kurtosis Imaging (DKI)

Diffusion tensor imaging (DTI) is the most commonly used technique to extract microstructural features from a set of diffusion-weighted images. In addition to the metrics obtained with DTI, diffusion kurtosis imaging (DKI) can provide non-Gaussian diffusion measures by means of the kurtosis tensor. DKI give an dimensionless measure that quantifies the deviation of the water diffusion displacement profile from the Gaussian distribution of unrestricted diffusion, providing a measure of the degree of diffusion hindrance or restriction. DKI has shown to be more sensitive to tissue microstructural changes in both normal and pathological neural tissue. The aim of this work is the description of t…

Comparative evaluation of data preprocessing software tools to increase efficiency and accuracy in diffusion kurtosis imaging

Characterization of Fricke gel dosimeters exposed to clinical photons beams and of MRI dosimetrical applications

Technical development in cardiac CT: current standards and future improvements—a narrative review

Non-invasive depiction of coronary arteries has been a great challenge for imaging specialists since the introduction of computed tomography (CT). Technological development together with improvements in spatial, temporal, and contrast resolution, progressively allowed implementation of the current clinical role of the CT assessment of coronary arteries. Several technological evolutions including hardware and software solutions of CT scanners have been developed to improve spatial and temporal resolution. The main challenges of cardiac computed tomography (CCT) are currently plaque characterization, functional assessment of stenosis and radiation dose reduction. In this review, we will discu…

CHIRURGIA NON INVASIVA AD ULTRASUONI FOCALIZZATI RM GUIDATI (MRGFUS) PER IL TRATTAMENTO DEI FIBROMI UTERINI SINTOMATICI: NOSTRA ESPERIENZA SULL'ELEGGIBILITÀ DELLE PAZIENTI

PRESENTAZIONE DI UN CASO DI MENINGOCELE SACRALE ANTERIORE: CARATTERISTICHE NEURORADIOLOGICHE E DIAGNOSI DIFFERENZIALE

SCOPO DEL LAVORO: Lo scopo di questo lavoro è documentare un caso di meningocele sacrale anteriore (Anterior Sacral Meningocele, ASM) rara forma di disrafismo spinale, diagnosticato in una giovane di 13 anni con riscontro ecografico di formazione cistica di verosimile pertinenza annessiale dopo visita Specialistica Ginecologica. La paziente si presenta con una clinica caratterizzata da: dolore pelvico, costipazione e cistiti ricorrenti. Sarà inoltre fatto un breve excursus sulle possibili diagnosi differenziali con altre masse pelviche a sviluppo presacrale. MATERIALI E METODI: A seguito di consulenza ginecologica, la paziente è stata sottoposta ad una ecografia transaddominale, che ha e…

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

Improvement of neutron sensitivity for lithium formate ESR dosimeters: A Monte Carlo analysis

This work presents the computational analysis of the sensitivity improvements that could be achieved in lithium formate monohydrate (LFM) electron paramagnetic resonance (EPR) dosemeters exposed to neutron beams. Monte Carlo (MC) simulations were performed on LFM pellets exposed to neutron beams with different energy spectra at various depths inside a water phantom. Various computations were carried out by considering different enrichments of 6Li inside the LFM matrix as well as addition of different amounts of gadolinium oxide inside the pellet blend. The energy released per unit mass was calculated with the aim of redicting the increase in dose achievable by the addition of sensitizers in…

Chirurgia trans-cranica mediante ultrasuoni focalizzati ad alta intensità su guida RM (trans-cranial MRI-guided Focused Ultrasound Surgery, tcMRgFUS): esperienza preliminare a 1,5T

Scopo del Lavoro Presentiamo i risultati preliminari ottenuti con la prima istallazione italiana di un’apparecchiatura tcMRgFUS (prima ed unica apparecchiatura al mondo installata su uno scanner RM da 1,5T) per trattamenti di neurochirurgia funzionale in pazienti con tremore essenziale, Parkinson idiopatico unilaterale prevalentemente tremorigeno e dolore neuropatico. Materiali e Metodi Sono stati arruolati pazienti con disordini neurologici resistenti a terapia medica. I pazienti eleggibili sono stati sottoposti ad esame TC ed RM di screening per escludere controindicazioni al trattamento. I trattamenti tcMRgFUS sono stati eseguiti da un gruppo multidisciplinare ottimizzando i parametri di…

Broad neurodevelopmental features and cortical anomalies associated with a novel de novo KMT2A variant in Wiedemann-Steiner syndrome.

Abstract Wiedemann-Steiner syndrome (WDSTS) is a rare genetic disorder including developmental delay/intellectual disability (DD/ID), hypertrichosis cubiti, short stature, and distinctive facial features, caused by mutation in KMT2A gene, which encodes a histone methyltransferase (H3K4) that regulates chromatin-mediated transcription. Different neurodevelopmental phenotypes have been described within the WDSTS spectrum, including a peculiar Autism Spectrum Disorder (ASDs) subtype in some affected individuals. Here, we report a 9-year-old Caucasian male found by next-generation panel sequencing to carry a novel heterozygous de novo KMT2A frameshift variant (NM_001197104.2:c.4433delG; p. Arg1…

Nanosystem for diagnosis and photothermal treatment of tumors

The invention relates to a nanosystem for the diagnosis, image-guided treatment of tumors and monitoring of the tumor microenvironment. The nanosystem is a contrast agent comprising a polymer shell based on a hyaluronic acid nanogel, super-parameg-netic iron oxide nanoparticles (SPIONs) and carbon nanoparticles (CDs).

Computer tomography features of pulmonary vascular involvement in Behçet's disease

Behçet’s disease is a chronic and multisystemic inflammatory vascular disease of unknown etiology, affecting vessels of all kinds and sizes. The involvement of the vascular system is observed in approximately 5-30% of patients. The most frequent vascular manifestations are venous thrombosis followed by arterial aneurysms and arterial thrombosis. The identification of vascular involvement is very important for prognosis, indeed the rupture of an arterial aneurysm represents the leading cause of sudden death in patients with Behçet’s disease. Computed tomography (CT) plays a crucial role in the identification and in the follow-up of vascular involvement. In this paper, we report the case of a…

Studio e calibrazione della risposta ottica ed NMR di dosimetri gel di tipo Fricke (FXG) in campi misti neutroni-gamma per applicazioni cliniche

Transcranial magnetic resonance-guided focused ultrasound thalamotomy as a safe treatment option in multiple sclerosis patients with essential tremor

Transcranial magnetic resonance-guided focused ultrasound is a recently introduced incisionless treating option for essential tremor and tremor-dominant idiopathic Parkinson disease. There is preliminary evidence that it may result in a promising effective treatment option for other movement disorders too. Here, we report on two patients with multiple sclerosis with medication refractory debilitating essential tremor comorbidity who successfully underwent unilateral Vim tcMRgFUS thalamotomy for tremor control. Patients' clinical condition and expanded disability status scale scores showed no changes during the 1-year follow-up period with no evidence of multiple sclerosis activity or progre…

Isolated, subtle, neurological abnormalities in neurologically and cognitively healthy aging subjects

The aim of this study is to describe the frequency of isolated, subtle, neurological abnormalities (ISNAs) in a large population of neurologically and cognitively healthy subjects and to compare ISNAs to various types of MRI-detected cerebrovascular lesions and subcortical brain atrophy in different age classes. 907 subjects were selected from a large, prospective hospital-based study. At baseline neurological examination, 17 ISNAs were selected. Primitive reflexes were the most common ISNAs (35.8 %), while dysphagia was the most rarely encountered (0.3 %). Measures of small vessel disease, i.e., deep and subcortical white matter hyperintensity and lacunar infarcts as well as subcortical at…

Lacrimal gland herniation in Graves ophthalmopathy: a simple and useful MRI biomarker of disease activity

Lacrimal gland (LG) involvement in patients with Graves ophthalmopathy (GO) has been considered as a potential cause of the associated GO symptoms and different studies demonstrated the LG involvement in patients with GO than healthy controls. The aim of this study was to evaluate LG involvement, through measurement of its herniation, using a magnetic resonance imaging (MRI) index, in patients with different GO activities. Thirty-two consecutive Caucasian patients affected by GO were enrolled and grouped in group A (16 with inactive GO, CAS < 3) and B (16 with active GO, CAS ≥ 3) according to their GO activity. All patients underwent clinical-endocrinological assessment, a complete ocular e…

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

Vitamin D and Parkinson's Disease.

Vitamin D is a fat-soluble secosteroid, traditionally considered a key regulator of bone metabolism, calcium and phosphorous homeostasis. Its action is made possible through the binding to the vitamin D receptor (VDR), after which it directly and indirectly modulates the expression of thousands of genes. Vitamin D is important for brain development, mature brain activity and associated with many neurological diseases, including Parkinson’s disease (PD). High frequency of vitamin D deficiency in patients with Parkinson’s disease compared to control population was noted nearly twenty years ago. This finding is of interest given vitamin D’s neuroprotective effect, exerted by the action of neur…

Preoperative evaluation of peripheral nerve injuries: What is the place for ultrasound?

OBJECTIVE The purpose of this study was to evaluate the usefulness of ultrasound in the preoperative workup of peripheral nerve lesions and illustrate how nerve ultrasonography can be integrated in routine clinical and neurophysiological evaluation and in the management of focal peripheral nerve injuries. The diagnostic role and therapeutic implications of ultrasonography for different neuropathies are described. METHODS The authors analyzed the use of ultrasound in 119 entrapment, tumoral, posttraumatic, or postsurgical nerve injuries of limbs evaluated in 108 patients during 2013 and 2014. All patients were candidates for surgery, and in all cases the evaluation included clinical examina…

Physics, Techniques and Review of Neuroradiological Applications of Diffusion Kurtosis Imaging (DKI)

In recent years many papers about diagnostic applications of diffusion tensor imaging (DTI) have been published. This is because DTI allows to evaluate in vivo and in a non-invasive way the process of diffusion of water molecules in biological tissues. However, the simplified description of the diffusion process assumed in DTI does not permit to completely map the complex underlying cellular components and structures, which hinder and restrict the diffusion of water molecules. These limitations can be partially overcome by means of diffusion kurtosis imaging (DKI). The aim of this paper is the description of the theory of DKI, a new topic of growing interest in radiology. DKI is a higher or…

Internal carotid artery dissection in a patient with hemophilia A: a case report and literature review

Spontaneous cervical artery dissection (sCeAD) is the most common cause of ischemic stroke at a young age, but its pathogenetic mechanism and risk factors are not fully elucidated. It is reasonable to think that bleeding propensity, vascular risk factors such as hypertension and head or neck trauma, and constitutional weakness of the arterial wall together play a role in the pathogenesis of sCeAD. Hemophilia A is known to be an X-linked condition that leads to spontaneous bleeding in various tissues and organs. To date, a few cases of acute arterial dissection in patients with hemophilia have been reported, but the relationship between these two diseases has not been studied so far. In addi…

TRANS-FUSIMO: preliminary in-vivo animal results of MR-guided focused ultrasound of liver under respiratory motion

Purpose: Treating liver tumors using Focused Ultrasound (FUS) is a great challenge. Prior to human applications, an in-vivo animal trial using the TRANS-FUSIMO treatment system (TTS) is ongoing in order to evaluate the safety and the technical efficacy and efficiency of generating predefined necrotic lesions. Methods and Materials: The trial includes a crossbred porcine model of thirty large white swine (all females; 55-85Kg) that will be treated using the TTS under general anaesthesia with intubation. All treatments haven been performed under ventilator-controlled breathing and using an improved non-clinical prototype FUS transducer integrated with a 1,5T MRI unit; a set of interventional …

EMORRAGIA IN TUMOR DA NEURINOMA DELL’VIII N.C. & SIMDROMI PARALITICHE ANTERIORE E POSTERIORE IMPROVVISA: SEMEIOTICA RADIOLOGICA

Gli autori riportano un raro caso clinico di una paziente di 77 anni che giunge alla nostra osservazione in regime di urgenza per vertigine improvvisa associata a nausea e vomito, stato confusionale, atassia, paralisi completa del VI nervo cranico di destra con strabismo convergente, segni di sofferenza del IX, X ed XI nervo cranico omolaterali all’abducente e iniziale comparsa di segni statici e dinamici di paralisi periferica del VII nervo cranico di destra. L’insorgenza improvvisa di Sindromi paralitiche associate, anteriori e posteriori, ha indirizzato verso il sospetto di lesione occupante spazio a sede in fossa cranica posteriore/tronco encefalo richiedendo pertanto l’ausilio della di…

Sudden sensorineural hearing loss as prodromal symptom of anterior inferior cerebellar artery infarction.

Sudden sensorineural hearing loss is a clinical condition characterized by a sudden onset of unilateral or bilateral hearing loss. In recent years sudden deafness has been frequently described in association with anterior inferior cerebellar artery (AICA) infarction generally presenting along with other brainstem and cerebellar signs such as ataxia, dysmetria and peripheral facial palsy. The authors report a rare clinical case of a 53-year-old man who suddenly developed hearing loss and tinnitus without any brainstem or cerebellar signs. Computed tomography of his brain was normal, and the audiological results localized the lesion causing deafness to the inner ear. Surprisingly, magnetic re…

DESCRIZIONE DI UN CASO DI LESIONE REVERSIBILE DELLO SPLENIO DEL CORPO CALLOSO IN PAZIENTE CON MONONUCLEOSI INFETTIVA DA COINFEZIONE EPSTEIN-BARR VIRUS (EBV) E CITOMEGALOVIRUS (CMV)

SCOPO Presentiamo un caso di encefalite virale con lesione reversibile dello splenio del corpo calloso (SCC) in un ragazzo di 16 anni con mononucleosi infettiva da coinfezione Epstein-Barr Virus (EBV) e Citomegalovirus (CMV). MATERIALI E METODI Il paziente, a causa della comparsa improvvisa di stato confusionale, irrigidimento e movimenti involontari alternati a tremori in corso di mononucleosi infettiva, giungeva in PS, dove eseguiva una TC encefalo (Siemens SOMATOM Definition AS+ - 128 strati) in condizioni di base ed in tecnica sequenziale, che non evidenziava reperti significativi. Veniva quindi ricoverato con il sospetto di encefalite virale e, il giorno successivo, veniva sottoposto a…

Sensibilità e stabilità dei dosimetri gel di tipo Fricke esposti ai fotoni nel range clinico in funzione della concentrazione di ferro: 3D MRI ed applicazioni dosimetriche

SEMI-AUTOMATIC VOLUMETRIC SEGMENTATION OF THE UPPER AIRWAYS IN PATIENTS WITH PIERRE ROBIN SEQUENCE

Pierre Robin malformation is a rare craniofacial dysmorphism whose pathogenesis is multifactorial. Although there is some agreement in non-invasive treatment in less severe cases, the dispute is still open on cases with severe respiratory impairment. We present a semi-automatic novel diagnostic tool for calculating upper airway volume, in order to eventually address surgery in patients with Pierre Robin Sequence (PRS). Multidetector CT datasets of two patients and two controls were tested to assess the proposed method for ROI segmentation, upper airway volume computation and three-dimensional reconstructions. The experimental results show an irregular pattern and a severely reduced cross-s…

STUDIO DI SEGMENTAZIONE MORFOVOLUMETRICA IN PAZIENTI CON DECLINO COGNITIVO LIEVE, MALATTIA DI ALZHEIMER E MALATTIA DI PARKINSON

Preliminary experience with a transcranial magnetic resonance-guided focused ultrasound surgery system integrated with a 1.5-T MRI unit in a series of patients with essential tremor and Parkinson's disease.

OBJECTIVETranscranial magnetic resonance–guided focused ultrasound surgery (tcMRgFUS) is one of the emerging noninvasive technologies for the treatment of neurological disorders such as essential tremor (ET), idiopathic asymmetrical tremor-dominant Parkinson’s disease (PD), and neuropathic pain. In this clinical series the authors present the preliminary results achieved with the world’s first tcMRgFUS system integrated with a 1.5-T MRI unit.METHODSThe authors describe the results of tcMRgFUS in a sample of patients with ET and with PD who underwent the procedure during the period from January 2015 to September 2017. A monolateral ventralis intermedius nucleus (VIM) thalamic ablation was pe…

EMANGIOPERICITOMA INTRACRANICO PRESENTAZIONE DI UN CASO E REVISIONE DELLA LETTERATURA

SCOPO DEL LAVORO Presentiamo a un caso di emangiopericitoma (HPC) in un paziente emicranico (maschio, 49 enne) che giunge alla nostra attenzione per l’insorgenza di confusione mentale e emisindrome sentitivo-motoria destra. Saranno inoltre riportati alcuni cenni sulla classificazione internazionale di questo raro tumore mesenchimale riccamente vascolarizzato, non tralasciando le possibili diagnosi differenziali con altri più comuni espansi di pertinenza extra- assiale. MATERIALI E METODI Dopo una prima valutazione in PS il paziente è stato sottoposto a esame TC encefalo e trasferito nel reparto di neurochirurgia. Successivamente ad un esame RM encefalo con sequenze morfologiche convenzion…

Conventional MRI-Derived Biomarkers of Adult-Type Diffuse Glioma Molecular Subtypes: A Comprehensive Review.

The introduction of molecular criteria into the classification of diffuse gliomas has added interesting practical implications to glioma management. This has created a new clinical need for correlating imaging characteristics with glioma genotypes, also known as radiogenomics or imaging genomics. Although many studies have primarily focused on the use of advanced magnetic resonance imaging (MRI) techniques for radiogenomics purposes, conventional MRI sequences remain the reference point in the study and characterization of brain tumors. A summary of the conventional imaging features of glioma molecular subtypes should be useful as a tool for daily diagnostic brain tumor management. Hence, t…

ETHANOL PREFERENCE DURING PREGNANCY AFTER LONG-TERM ETHANOL CONSUMPTION: EFFECT OF DRINKING PATTERN AND MATERNAL BEHAVIOUR ANALYSIS

Several studies suggest that pregnancy can reduce ethanol preference and consumption in rats and mice when self-administration starts early during pregnancy (Randall et al., 1980; Means and Goy, 1982). Our first aim was to explore the effect of pregnancy on long-term habit to ethanol, in female rats subjected to 12-week continuous or intermittent (3 days/week) access to 20% ethanol; they were named CARs and IARs respectively. The second aim was to observe their maternal behaviour. Rats were deprived from ethanol during mating and the first gestational week, and then re-exposed to respective ethanol self-administration schedule, starting from the second week of pregnancy. Maternal behaviour …

MR-guided focused ultrasound application for moving target tumor ablation in abdominal area: Coil selection

PubMed: 32276552

Il punteggio MNA come correlato indipendente della dispnea nell'anziano con BPCO

23. 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…

Restoring Neurological Physiology: The Innovative Role of High-Energy MR-Guided Focused Ultrasound (HIMRgFUS). Preliminary Data from a New Method of Lesioning Surgery

Background Tremor is a disabling condition, common to several neurodegenerative diseases. Lesioning procedures and deep brain stimulation, respectively, of the ventralis intermedius nucleus for intentional tremor, and of the subthalamic nucleus for parkinsonian resting tremor, have been introduced in clinical practice for patients refractory to medical treatment. The combination of high-energy focused ultra-sound (HIFUS) with sophisticated magnetic resonance (MR) instrumentation, together with accurate knowledge of the stereotactic brain coordinates, represents a revolution in neuromodulation. Methods At the Neurosurgical Clinic and the Radiology Department of the University of Palermo,, tw…

Transcranial Magnetic Resonance Imaging-Guided Focused Ultrasound with a 1.5 Tesla Scanner: A Prospective Intraindividual Comparison Study of Intraoperative Imaging

Background: High-quality intraoperative imaging is needed for optimal monitoring of patients undergoing transcranial MR-guided Focused Ultrasound (tcMRgFUS) thalamotomy. In this paper, we compare the intraoperative imaging obtained with dedicated FUS-Head coil and standard body radiofrequency coil in tcMRgFUS thalamotomy using 1.5-T MR scanner. Methods: This prospective study included adult patients undergoing tcMRgFUS for treatment of essential tremor. Intraoperative T2-weighted FRFSE sequences were acquired after the last high-energy sonication using a dedicated two-channel FUS-Head (2ch-FUS) coil and body radiofrequency (body-RF) coil. Postoperative follow-ups were performed at 48 h usin…

Malignancy course of pituitary adenoma in MEN1 syndrome: Clinical-Neuroradiological signs

Pituitary carcinomas (PCa) are extremely rare, indistinguishable from pituitary adenomas on histopathological grounds and have a poor prognosis. Most PCa start as PRL or ACTH secreting tumors in males, with relapsing invasive behaviour, refractoriness to medical and radiotherapy and increasing hormonal levels. The presence of distant metastases is still required for the diagnosis of PCa. The association with genetic endocrine diseases must be taken into account, since it adds further risk of evolution towards malignancy. Intradural spinal metastases have also been reported, so a complete craniospinal MR evaluation is recommended, when clinically indicated. We report a case of PCa, associate…

The Presence of White Matter Lesions Is Associated With the Fibrosis Severity of Nonalcoholic Fatty Liver Disease

Abstract We tested whether nonalcoholic fatty liver disease (NAFLD) and/or its histological severity are associated with vascular white matter lesions (WML) in patients with biopsy-proven NAFLD and in non-NAFLD controls. Data were recorded in 79 consecutive biopsy-proven NAFLD, and in 82 controls with normal ALT and no history of chronic liver diseases, without ultrasonographic evidence of steatosis and liver stiffness value  45 years (OR 3.09, 95% CI: 1.06–9.06, P = 0.03; and OR 11.1, 95% CI: 1.14–108.7, P = 0.03), and F2–F4 fibrosis (OR 3.36, 95% CI: 1.29–8.73, P = 0.01; and OR 5.34, 95% CI: 1.40–20.3, P = 0.01) were independently associated with WML (mostly of mild grade) by multivariate…

Sensorineural Hearing Loss: Pathophysiology, Diagnosis and Treatment [Chapter 5. Neuroradiology of the Hearing System]

Hearing loss is one of the most frequent indications for CT and MR examinations of the auditory system. Such a symptomatology is becoming increasingly common in today’s society and is extremely disturbing for patients. Causes may involve the auditory pathway at any level. In most cases, neuroradiological examinations represents a mandatory step, within a multidisciplinary workup, towards final diagnosis, therapeutic plan and subsequent follow-ups. This chapter will introduce this critical topic starting from an imaging-based exposition of the anatomy and function of the auditory system. The chapter will include some hints on the choice of the best imaging examination to perform on each pati…

Human Spheroids from Adipose-Derived Stem Cells Induce Calvarial Bone Production in a Xenogeneic Rabbit Model

ABSTRACT: Calvarial defects can result from several causes. Tissue engineering hold the potential to restore native form and protective function. We have recently shown that stemness and differentiation ability of spheroids from adipose-derived stem cells (S-ASCs) promotes osteoblasts growth within Integra in a small vertebral lesion. In our study, we aimed to test osteogenic potential of S-ASCs in aiding regeneration of a calvarial defect. Groups containing Integra showed increased bone regeneration at the calvarial defect-Integra interface compared with the control group. In particular, S-ASC-derived osteoblasts group showed a superior calvarial remodeling than undifferentiated S-ASCs gro…

NMR relaxometry measurements of Fricke gel dosimeters exposed to neutrons

Fricke infused gel matrices offer several features making them suitable for dosimetric applications; among the set here are tissue equivalence, low cost and ease of preparation. Their nuclear magnetic resonance (NMR) relaxation properties can be used as a radiation detector for the dosimetry of beams used in cancer therapy. In recent years neutron capture therapy has been resumed for the treatment of various types of cancer and it requires three-dimensional mapping of the neutron fields. In this work, we investigated this particular application through NMR relaxometry and MR imaging of Fricke gels exposed to neutrons. We analyzed both the R1 and R2 relaxation rates, which relate to the long…

Is trans-cranial MR-guided Focused UltraSound a repeatable treatment option? Report of a successfully re-treated patient

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. Hi…

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 observation 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. T…

Diffusion and sensitivity characteristics of a chemically cross-linked PVA-Fricke gel dosimeter

TRANS-CRANIAL MRI-GUIDED FOCUSED ULTRASOUND SURGERY (TCMRGFUS): ITALIAN AND WORLD-FIRST EXPERIENCE AT 1.5 TESLA

Introduction: Transcranial magnetic resonance-guided focused ultrasound surgery (tcMRgFUS) is a promising new technology for the noninvasive treatment of various brain disorders. Here, we present our preliminary results achieved with the first Italian installation of a transcranial MRI-guided focused ultrasound surgery (tcMRgFUS) certified system for functional neurosurgery. Technical issues faced to achieve a safe and effective treatment will be discussed focusing on MR high-resolution live imaging and thermometry sequences optimization. Materials and Methods: Patient enrollment was based on indication for functional neurosurgery and evidence of medication-refractory disease; a detailed me…

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

Neuroanatomical changes in early Parkinson’s disease with mild cognitive impairment: a VBM study; the Parkinson’s Disease Cognitive Impairment Study (PaCoS)

Introduction: Mild cognitive impairment (MCI) is common in Parkinson’s disease (PD), but the underlying pathological mechanism has not been fully understood. Voxel-based morphometry could be used to evaluate regional atrophy and its relationship with cognitive performances in early PD-MCI. Patients and Methods: One hundred and six patients with PD were recruited from a larger cohort of patients, the Parkinson’s Disease Cognitive Impairment Study (PaCoS). Subject underwent a T1-3D MRI and a complete clinical and neuropsychological evaluation. Patients were divided into PD with normal cognition (PD-NC) and PD-MCI according to the MDS level II criteria–modified for PD-MCI. A subgroup of early …

Agarose and PVA Fricke gel dosimeters exposed to clinical photons beams: Nuclear Magnetic Resonance Relaxometry and Imaging

Fricke Xylenol Gel (FXG) dosimetric system is based on the radiation induced oxidation of ferrous (Fe2+) to ferric (Fe3+) ions. The application of Fricke gels for ionizing radiation dosimetry is continuously increasing worldwide due to their many favorable properties. However, one of their shortcomings is that ferrous and ferric ions diffuse in the gel matrix. To maintain the spatial integrity of the dose distribution, Fricke gels must be undergoing measurement within a few hours of their irradiation, so that ferric ions remain close to their point of production. Thus, the spatial integrity of the dose distribution in the Fricke gel is maintained. The gel matrix also contributes to the oxid…

EMERGING ROLE OF ULTRASOUND IMAGING ASSOCIATED TO CLINICAL NEUROPHYSIOLOGY AS A SUPPLEMENTARY DIAGNOSTICS TECHNIQUE OF PERIPHERAL NERVES PATHOLOGIES: A SICILIAN EXPERIENCE

PURPOSE: to show the relevance of peripheral nerve ultrasound imaging as a supplementary technique in a clinical neurophysiological evaluation. METHODS: peripheral nerves ultrasound (US) examination was performed in patients with a medical history of nerve entrapment and/or post-traumatic neuropathy but with clinical or neurophysiological unusual findings. A 10-18 MHz transducer was used. RESULTS: we recruited 50 patients with clinical evidence of peripheral neuropathies (25M, 25F): 24 median nerves, 1 anterior interosseous, 14 ulnar, 3 brachial plexus, 2 posterior interosseus, 1 superficial radial, 1 superficial peroneal and 4 common peroneal nerves. Overall 20/50 patients had a history of…

IMAGING OF VESTIBULAR SCHWANNOMA [Chapter 4]

Lesions of the cerebellopontine angle and internal auditory canal are a frequent finding in neuroradiological examinations and their detection may represent a diagnostic challenge. Among these lesions, vestibular schwannomas and meningiomas are certainly the most frequent and account for up to 90% of all cerebellopontine angle tumours. The remaining ones are a group of lesions arising from the different structures found in these anatomical regions such as haemangiomas, lipomas, lymphomas, facial nerve tumours, and aneurysms. This chapter will introduce this topic focusing on a practical coverage of the typical and atypical neuroradiological signs that will drive towards the most correct dif…

Iperreattività bronchiale e inspirazione profonda: correlazioni patogenetiche e implicazioni cliniche

Bronchial hyperreactivity seems to induce a loss of the deep inspiration's bronchoprotective effect which is normally able to dilate the obstructed airways. Studies such as the HRCT on the bronchial gauge's alterations show that the deep inspirations bronchodilator effect is associated with the bronchial distensibility. In fact, it is almost totally absent either in the elderly or in the COPD patients. In asthma, instead, the pathology's seriousness has proved to be associated with the impairment of the deep inspiration's broncho-protective effect which this way becomes an important diagnostic parameter.

Sviluppo di un software per l’analisi di immagini di Diffusion Kurtosis Imaging

L’analisi mediante RM del tensore di diffusione (Diffusion Tensor Imaging, DTI) consente di valutare anche in vivo e con modalità non invasive il processo di diffusione delle molecole d’acqua nei tessuti biologici. La peculiare organizzazione di alcuni tessuti biologici (es: muscoli, sostanza bianca del sistema nervoso centrale e tessuti ad alta cellularità) influenza tale fenomeno rendendolo anisotropo e quindi ben valutabile con tali tecniche di studio. Nonostante i grandi vantaggi di tale tecnica, il DTI è basato su un modello molto semplificato che assume che lo spostamento per diffusione segua un profilo gaussiano il che è molto raro in un ambiente variegato come i tessuti biologic…

Modulation of Human Motor Cortical Excitability and Plasticity by Opuntia Ficus Indica Fruit Consumption: Evidence from a Preliminary Study through Non-Invasive Brain Stimulation

Indicaxanthin (IX) from Opuntia Ficus Indica (OFI) has been shown to exert numerous biological effects both in vitro and in vivo, such as antioxidant, anti-inflammatory, neuro-modulatory activity in rodent models. Our goal was to investigate the eventual neuro-active role of orally assumed fruits containing high levels of IX at nutritionally-relevant amounts in healthy subjects, exploring cortical excitability and plasticity in the human motor cortex (M1). To this purpose, we applied paired-pulse transcranial magnetic stimulation and anodal transcranial direct current stimulation (a-tDCS) in basal conditions and followed the consumption of yellow cactus pear fruits containing IX or white ca…

Chirurgia trans-cranica mediante ultrasuoni focalizzati ad alta intensità su guida RM: esperienza preliminare a 1,5T (prima paziente trattata)

Presentiamo i risultati preliminari ottenuti con la prima istallazione italiana di un’apparecchiatura per la neurochirurgia funzionale mediante ultrasuoni focalizzati ad alta intensità su guida RM (trans-cranial MRI-guided Focused Ultrasound Surgery, tcMRgFUS); si tratta tra l’altro della prima apparecchiatura tcMRgFUS al mondo mai installata su uno scanner RM da 1,5T. Tale apparecchiatura è destinata a trattamenti di neurochirurgia funzionale di pazienti con tremore essenziale (Essential Tremor, ET), Parkinson idiopatico (Parkinson Disease, PD) prevalentemente tremorigeno e dolore neuropatico (Neuropa- thic Pain, NP). Sanno presentati i risultati ottenuti con i primi pazienti sottoposti …

Dependence of MRI sensitivity of Fricke gel dosimeters exposed to clinical photons beams on ferrous ammonium sulfate content

FUNCTIONAL CONNECTIVITY MODULATION INDUCED BY TRANSCRANIAL DIRECT CURRENT STIMULATION OF THE MOTOR NETWORK

Background: Brain functions arise from the orchestrated activation and cooperation of networks of regions whose specific relationship varies dynamically across functional states. Resting state functional Magnetic Resonance Imaging (RS-fMRI) analyses focuses on spontaneous low frequency fluctuations (< 0.1 Hz) in the BOLD signal and investigates synchronous activations between regions that are spatially distinct (functional connectivity, FC), occurring in the absence of a task or stimulus. Transcranial Direct Current Stimulation (tDCS) is a non-invasive brain stimulation technique that is known to modulate cortical activity and FC among brain regions, as measured by functional Magnetic Reson…

The presence of white matter lesions is not associated with non-alcoholic fatty liver disease but with its histological severity

The presence of White Matter Lesions is not associated with Non-alcoholic Fatty Liver Disease but with its histological severity

246. Analysis of signal-to-noise ratio for a 2-channels coil developed to enable transcranial Magnetic Resonance-guided Focused Ultrasound Surgery (tcMRgFUS) with 1.5 T MRI scanners

Abstract Purpose In recent years trans-cranial Magnetic Resonance-guided Focused Ultrasound Surgery (tcMRgFUS) treatments have aroused large scientific and medical interest [1] . Usually, tcMRgFUS systems are integrated with 3 T systems which allow the use of the body RF coil for both real time imaging and MR-thermometry. At University Hospital of Palermo there is the world-first installation of a tcMRgFUS system integrated with a 1.5 T scanner. Here we present the characterization in terms of signal-to-noise ratio (SNR) of a dedicated RF coils suitably developed (by InSightec) to enable tcMRgFUS treatments with 1.5 T MR units. Methods and materials The focused ultrasound equipment (ExAblat…

Brain Mapping-Aided SupraTotal Resection (SpTR) of Brain Tumors: The Role of Brain Connectivity

Brain gliomas require a deep knowledge of their effects on brain connectivity. Understanding the complex relationship between tumor and functional brain is the preliminary and fundamental step for the subsequent surgery. The extent of resection (EOR) is an independent variable of surgical effectiveness and it correlates with the overall survival. Until now, great efforts have been made to achieve gross total resection (GTR) as the standard of care of brain tumor patients. However, high and low-grade gliomas have an infiltrative behavior and peritumoral white matter is often infiltrated by tumoral cells. According to these evidences, many efforts have been made to push the boundary of the re…

Functional connectivity modulation induced by transcranial direct current stimulation of the motor network: a Resting-State fMRI study

Resting-state functional connectivity represents a novel fMRI approach that allows detection of temporal correlations in spontaneous BOLD signal oscillations while subjects rest quietly in the scanner. Functional connectivity (FC) can be defined as the synchrony of neural activity among spatially distant regions. Transcranial direct current stimulation (tDCS) is a non-invasive brain stimulation technique that is known to modulate cortical activity and FC among brain regions. This study is aimed at measuring the variation of functional connectivity between cortical brain regions after tDCS along time. The temporal concatenation group ICA showed that immediately after anodal stimulation the a…

Referenceless thermometry using radial basis function interpolation

The Proton Resonance Frequency (PRF) shift provide a method for temperature change measurements during thermotherapy. Conventional PRF thermometry works subtracting one or multiple baseline images. The method leads to artifacts caused by tissue motion and frequency drift. Various works estimating the background phase from each acquired image phase are present in literature. These algorithms are called “referenceless” because they don’t require any subtraction of baseline images for calculating temperature increment. Conventional referenceless methods estimate baseline image by fitting the background phase outside the heated region through a polynomial approach. In this work a background pha…

Increased functional connectivity in gambling disorder correlates with behavioural and emotional dysregulation: Evidence of a role for the cerebellum

Gambling disorder (GD) is a psychiatric disease that has been recently classified as a behavioural addiction. So far, a very few studies have investigated the alteration of functional connectivity in GD patients, thus the concrete interplay between relevant function-dependent circuitries in such disease has not been comprehensively assessed. The aim of this research was to investigate resting-state functional connectivity in GD patients, searching for a correlation with GD symptoms severity. GD patients were assessed for gambling behaviour, impulsivity, cognitive distortions, anxiety and depression, in comparison with healthy controls (HC). Afterwards, they were assessed for resting-state f…

A novel automated tool for calculating upper airways volume in patients with isolated Pierre Robin Sequence (IPRS).

Purpose Methods and Materials Results Conclusion References Personal Information

A 2D-FEM Model of Nonlinear Ultrasound Propagation in Trans-cranial MRgFUS Technique

Magnetic Resonance guided Focused Ultrasound (MRgFUS) is a non-invasive technique based on the thermal ablation of a target using high intensity focused ultrasound. MRgFUS treatment applied to brain is challenging due to the skull presence that attenuates ultrasound, leading to heating effects in bone region. In this study, we simulate trans-cranial nonlinear ultrasound propagation considering the detailed structure of bone tissue. We developed a 2D Finite Element (FE) model that mimics the propagation of focused ultrasound through skin, skull and brain tissue. The skull is represented as a three-layered system with two cortical tables packing a layer of trabecular bone. We assume that the …

Neurophysiological and ultrasonographic exams in nerve patologies: diagnostic work-up and monitoring.

Introduzione: le patologie dei nervi sono causa di disabilità nella popolazione giovane adulta affetta e motivo di contenzioso medico-legale per molti chirurghi. Obiettivi: valutare la rilevanza dell’ecografia del nervo e dell’esame neurofisiologico nella valutazione prechirurgica e nel follow-up post-chirurgico ai fini diagnostici, prognostici e di adeguata programmazione terapeutica. Materiali e Metodi: pazienti con patologia da intrappolamento o post-traumatica sono stati sottoposti a valutazione clinica, neurofisiologica ed ecografica. Risultati: abbiamo studiato 50 neuropatie (25M, 25F): 23 nervi mediani, 1 interosseo anteriore, 14 nervi ulnari, 3 plessi brachiale, 2 interossei posteri…

Analisi NMR su gel di tipo Fricke irradiati con fasci routinari per la radioterapia: stabilità e sensibilità in funzione degli additivi

In questo lavoro sono presentate le misure effettuate tramite rilassometria NMR su campioni costituiti da una matrice gelatinosa drogata con ioni ferrosi comunemente chiamati dosimetri gel di tipo Fricke (FXG). La dosimetria con gel Fricke si basa sulla ossidazione degli ioni ferrosi (Fe2+) in ioni ferrici (Fe3+) all’interno di una matrice gelatinosa a seguito di irraggiamento (Schreiner, 2004). Tale processo è fortemente dipendente dalla dose somministrata (Marrale, 2014a). I dosimetri di Fricke sono tessuto-equivalenti, rispondono ad ogni tipo di radiazione ionizzante ed, assumendo la forma del contenitore in cui avviene la gelificazione, possono essere utilizzati per studiare l’effetto d…

Imaging of Substantia Nigra in Parkinson's Disease: A Narrative Review.

Parkinson’s disease (PD) is a progressive neurodegenerative disorder, characterized by motor and non-motor symptoms due to the degeneration of the pars compacta of the substantia nigra (SNc) with dopaminergic denervation of the striatum. Although the diagnosis of PD is principally based on a clinical assessment, great efforts have been expended over the past two decades to evaluate reliable biomarkers for PD. Among these biomarkers, magnetic resonance imaging (MRI)-based biomarkers may play a key role. Conventional MRI sequences are considered by many in the field to have low sensitivity, while advanced pulse sequences and ultra-high-field MRI techniques have brought many advantages, partic…

Looking into the architecture of the brain with MRI: quantification of non-Gaussian water diffusion by Diffusion Kurtosis Imaging (DKI)

The aim of this work is the definition of an MRI protocol for Diffusion Kurtosis Imaging (DKI) by using a 1.5T clinical scanner and the development of a software for DKI analysis.

Simulazioni numeriche e test di applicabilità clinica della Diffusion Kurtosis Imaging su tomografi RM da 1.5 Tesla

Intraoperative imaging findings in transcranial MR imaging-guided focused ultrasound treatment at 1.5T may accurately detect typical lesional findings correlated with sonication parameters

To assess the intraoperative neuroimaging findings in patients treated with transcranial MR-guided focused ultrasound (tcMRgFUS) thalamotomy using 1.5T equipment in comparison with the 48-h follow-up.Fifty prospectively enrolled patients undergoing unilateral tcMRgFUS thalamotomy for either medication-refractory essential tremor (n = 39) or Parkinson tremor (n = 11) were included. Two radiologists evaluated the presence and size of concentric lesional zones (zone I, zone II, and zone III) on 2D T2-weighted sequences acquired intraoperatively after the last high-energy sonication and at 48 h. Sonication parameters including number of sonications, delivered energy, and treatment temperatures …

Cerebral abscesses imaging: A practical approach

Abstract: Brain abscesses (BAs) are focal infections of the central nervous system (CNS) that start as a localised area of weakening of the brain parenchyma (cerebritis) and develops into a collection of pus surrounded by a capsule. Pyogenic (bacterial) BAs represent the majority of all BAs; in some cases, the diagnostic and therapeutic management can be challenging. Imaging has a primary role in differentiating BAs from other lesions. Conventional magnetic resonance imaging (cMRI) is essential for the identification of the lesion, its localisation and its morphological features. However, cMRI does not allow to reliably differentiate BAs from other intracranial mass lesions such as necrotic…

Magnetic Resonance Imaging Derived Biomarkers of IDH Mutation Status and Overall Survival in Grade III Astrocytomas

The evaluation of the isocitrate dehydrogenase (IDH) mutation status in the glioma decision-making process has diagnostic, prognostic and therapeutic implications. The aim of this study was to evaluate whether conventional magnetic resonance imaging (MRI) and apparent diffusion coefficient (ADC) can noninvasively predict the most common IDH mutational status (R132H) in GIII-astrocytomas and the overall survival (OS). Hence, twenty-two patients (9-F, 13-M) with a histological diagnosis of GIII-astrocytoma and evaluation of IDH-mutation status (12-wild type, 10-mutant) were retrospectively evaluated. Imaging studies were reviewed for the morphological feature and mean ADC values (ADCm). Stati…

HIPPOCAMPAL REVERSIBLE LESIONS IN A CASE OF TRANSIENT GLOBAL AMNESIA

PURPOSE: We present a case of transient global amnesia (TGA) onset in a 52-year-old male with a medical history of migraine. METHODS: Patient was taken to ER by his colleagues which reported that after an emotional stress he suddenly appeared perplexed and started asking repetitive questions. In ER a neurological examination excluded other neurological signs or symptoms and it was confirmed that cognitive impairment was limited to the amnesia domain; electroencephalography was unremarkable and he had no history of epileptic seizures or head trauma. At the neurologic examination Capland and Hodges criteria were fulfilled and the diagnostic hypothesis of TGA was placed. He underwent to a brai…

Radial Basis Function Interpolation for Referenceless Thermometry Enhancement

MRgFUS (Magnetic Resonance guided Focused UltraSound) is a new and non-invasive technique to treat different diseases in the oncology field, that uses Focused Ultrasound (FUS) to induce necrosis in the lesion. Temperature change measurements during ultrasound thermo-therapies can be performed through magnetic resonance monitoring by using Proton Resonance Frequency (PRF) thermometry. It measures the phase variation resulting from the temperature-dependent changes in resonance frequency by subtracting one phase baseline image from actual phase. Referenceless thermometry aims to re-duce artefacts caused by tissue motion and frequency drift, fitting the back-ground phase outside the heated reg…

POST-THALAMOTOMY NEUROFUNCTIONAL FINDINGS ON PATIENTS TREATED WITH TRANS-CRANIAL MAGNETIC RESONANCE GUIDED FOCUSED ULTRASOUND SURGERY (TCMRGFUS): PRELIMINARY RESULTS

BACKGROUND AND PURPOSE: We present functional connectivity (FC) changes found in the very first patients treated with the first Italian installation of a trans-cranial MRI-guided Focused Ultrasound Surgery (tcMRgFUS) certified system for functional neurosurgery. TcMRgFUS is a promising new technique for non-invasive treatment of neurologic disorders such as Essential Tremor, tremor associated to Parkinson's Disease and Neuropathic Pain. TcMRgFUS is able to focally target and destroy specific regions in the brain through intact skull, by using a high intensity focused ultrasound beam. Resting state functional Magnetic Resonance Imaging (RS-fMRI) analyses focuses on spontaneous low frequency …

Focused Ultrasound in Neuroscience. State of the Art and Future Perspectives

Transcranial MR-guided Focused ultrasound (tcMRgFUS) is a surgical procedure that adopts focused ultrasounds beam towards a specific therapeutic target through the intact skull. The convergence of focused ultrasound beams onto the target produces tissue effects through released energy. Regarding neurosurgical applications, tcMRgFUS has been successfully adopted as a non-invasive procedure for ablative purposes such as thalamotomy, pallidotomy, and subthalamotomy for movement disorders. Several studies confirmed the effectiveness of tcMRgFUS in the treatment of several neurological conditions, ranging from motor disorders to psychiatric disorders. Moreover, using low-frequencies tcMRgFUS sys…

A Semi-automatic Multi-seed Region-Growing Approach for Uterine Fibroids Segmentation in MRgFUS Treatment

Fibroids are benign tumors growing in the uterus. Most of fibroids do not require treatment unless they are causing symptoms. Traditional surgery treatments, like myomectomy and hysterectomy, are very invasive therapeutic approaches which not always preserves reproductive potential of the woman. MRgFUS, performed with Insightec ExAblate 2100 equipment, is a new and noninvasive technique for uterine fibroids treatment, not requiring hospitalization and recovery time for patients. An initial assessment of MRgFUS treatment is made by computing the ablated volume of uterine fibroid. In this paper a semi-automatic approach, based on region-growing segmentation technique, is proposed. The impleme…

Dopamine involvement in Acetaldehyde drinking behaviour: role of Ropinirole on.

Rats self-administer acetaldehyde(ACD), ethanol's first metabolite, directly into cerebral ventricles (1), and multiple ICV infusions of ACD produce conditioned place preference (2). ACD, such as alcohol and other substances of abuse, interacts with dopaminergic reward system (3) and its reinforcing and addictive properties have been assessed through an operant-conflict conditioning procedure (4). Since dopamine D2receptor over-expression in the Nacc attenuates alcohol intake (5), this study aims at exploring the effects of ropinirole administration during abstinence, on ACD relapse. The protocol has been scheduled into 3 different periods: training ( animals have been trained to self-admin…

Nasal anomalies review with CT or MRI: from congenital to malignant.

Learning Objectives. To describe imaging findings of a wide spectrum of uncommon nasal cavity masses evaluated at our institution by CT, CBCT and MR imaging, clinically and pathologically proven. Background. In this work we present a succinct review of disease illustrated by a retrospective case series of nasalcavity masses, evaluated at our institution. between 2010 and 2013. Patients have been studied with different imaging modalities including multiraw computed tomography (CT), cone beam computed tomography (CBCT) and magnetic resonance imaging (MR) to illustrate the findings and to summarize the main diagnostic keypoints for the differential diagnosis of nasal masses. Clinicopathologica…

PECULIARE EVOLUZIONE DELLA SEMEIOTICA NEURORADIOLOGICA DI UN CASO DI MALATTIA DEMIELINIZZANTE CON LESIONI PSEUDOTUMORALI

SCOPO DEL LAVORO Presentiamo un caso di una paziente di 24 anni che giunge alla nostra attenzione per la comparsa di disartria come quadro clinico d’esordio di una forma aggressiva di malattia demielinizzante di cui si valuta l’atipica evoluzione neuroradiologica delle lesioni pseudotumorali che la caratterizzano e le possibili diagnosi differenziali. MATERIALI E METODI La paziente dopo una prima valutazione in PS è stata sottoposta a TC encefalo, ricoverata presso l’U.O. di Neurologia, sottoposta a controlli RM seriati (anche con tecniche avanzate); durante la degenza è stata inoltre effettuata una biopsia stereotassica. RISULTATI La TC ha rilevato almeno tre lesioni ipodense: a sinistra…

Deep Learning Network for Segmentation of the Prostate Gland With Median Lobe Enlargement in T2-weighted MR Images: Comparison With Manual Segmentation Method

Purpose: Aim of this study was to evaluate a fully automated deep learning network named Efficient Neural Network (ENet) for segmentation of prostate gland with median lobe enlargement compared to manual segmentation. Materials and Methods: One-hundred-three patients with median lobe enlargement on prostate MRI were retrospectively included. Ellipsoid formula, manual segmentation and automatic segmentation were used for prostate volume estimation using T2 weighted MRI images. ENet was used for automatic segmentation; it is a deep learning network developed for fast inference and high accuracy in augmented reality and automotive scenarios. Student t-test was performed to compare prostate vol…

Hemorragic presentation of Listeria Monocytogenes rhombencephalic abscess.

Listeria monocytogenes (LM) bacterium is a cause of central nervous system (CNS) infection and the most common cause of rhombencephalitis in immunocompetent elderly. A prompt identification of this condition should be always desirable, since its clinical manifestations are often unspecific with prodromal symptoms leading to high rates of morbidity and mortality if underestimated. CNS listeriosis magnetic resonance imaging (MRI) findings are generally not specific. However, in the appropriate clinical setting, focal brainstem hyperintensity on T2-weighted pulse sequences associated with ring-enhancement pattern after i.v. contrast media injection should be suspicious of LM abscess. The diagn…

Contribution of ultrasound and clinical neurophysiology in 119 entrapment, post-traumatic/post-surgical neuropathies and tumors

HIFU for Bone Metastases and other Musculoskeletal Applications

AbstractHigh-intensity focused ultrasound (HIFU) is a totally noninvasive procedure that has shown promising results in the management of numerous malignant and nonmalignant conditions. Under magnetic resonance or ultrasound guidance, high-intensity ultrasound waves are focused on a small, well-defined target region, inducing biologic tissue heating and coagulative necrosis, thus resulting in a precise and localized ablation. This treatment has shown both great safety and efficacy profiles, and may offer a multimodal approach to different diseases, providing pain palliation, potential local tumor control, and, in some cases, remineralization of trabecular bone. In musculoskeletal field, HIF…

Studio di segmentazione morfovolumetrica in pazienti con declino cognitivo lieve amnestico (aMCI) e demenza di Alzheimer (AD) rispetto ad un gruppo di controllo (Normal Aging Brain, NAB)

SCOPO: Presentare i risultati preliminari di un’analisi di segmentazione morfovolumetrica (VBM) eseguita in pazienti con aMCI ed AD rispetto ad una popolazione di controllo (NAB). Tali dati saranno in futuro correlati ad altri parametri clinico-psicologici raccolti (età, sesso, scolarità, MMSE, ADL, IADL). MATERIALI E METODI: Sono stati sottoposti ad esame RM encefalo 103 soggetti, utilizzando uno scanner RM GE Signa HDxt da 1,5T ed acquisendo, tra le altre, una sequenza Sag 3D T1 FSPGR IR preped ASSET che è stata utilizzata per l’analisi VBM eseguita con il tool sienax (FSL). I risultati sono stati valutati in termini di valori medi e deviazioni standard mediante applicazione del t-test…

P1030 : The presence of white matter lesions is not associated with non-alcoholic fatty liver disease but with its histological severity

An edge-driven 3D region-growing approach for upper airway morphology and volume evaluation in patients with Pierre Robin sequence

Abstract: Pierre Robin sequence (PRS) is a pathological condition responsible for a sequence of clinical events, such as breathing and feeding difficulties, that must be addressed to give the patient at least a chance to survive. By using medical imaging techniques, in a non-intrusive way, the surgeon has the opportunity to obtain 3D views, reconstruction of the regions of interest (ROIs), useful to increase understanding of the PRS patient’s condition. In this paper, a semi-automatic approach for segmentation of the upper airways is proposed. The implemented approach uses an edge-driven 3D region-growing algorithm to segment ROIs and 3D volume-rendering technique to reconstruct the 3D mode…

Trattamento sclerotizzante retrogrado percutaneo del varicocele e risultati sui parametri seminali e sulla fertilità.

Comunicazione orale per XIII Congresso Nazionale della Società Italiana di Andrologia. Milano, 26-29 settembre 2006

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

fMRI (Risonanza Magnetica funzionale)

Ruolo della Risonanza Magnetica funzionale nel panorama delle tecniche RM "avanzate".

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

Ipofisi

Considerata l'elevata complessità anato-funzionale e le ridotte dimensioni delle strutture presenti nella regione sellare e ixuta-sellare, la parte introduttiva dell'intervento sarà obbligatoriamente dedicata a brevi richiami di fisiologia dell'asse ipotalamo-ipofisario, alla diagnostica di laboratorio (talvolta erroneamente considerata “di supporto” alla diagnostica per immagini) e all'anatomia radiologica; ciò consentirà di meglio comprendere la necessità di un assoluto rigore nei protocolli d'esame utilizzati per ottenere immagini di elevata affidabilità diagnostica. Sarà dato ampio spazio ai protocolli di studio e saranno discusse le principali indicazioni allo studio di tali dis…

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

Paradoxical arterial priapism: post-traumatic monolateral low penile perfusion and curvature associated to contro-lateral arterious-cavernous aceration and fistulization.

Poster for IX Congress of the European Society for Sexual Medicine. Vienna, Dicember 3th – 6th 2006