A liquid biopsy model to detect eventual pollutants as “one health” tool

Environmental pollution (EP), defined as the unfavorable chemical and physical alterations of our surroundings, still represents a relevant issue of this century. In this scenario, several changes may directly or indirectly impact on human health by promoting neoplastic cell transformation due to DNA damage in human tissue. The identification of a specific molecular signature observed in people exposed to environmental contaminants could improve risk calculation of exposition. As regards, DNA methylation is considered an epigenetic modification that could play a pivotal role in the risk calculation of patients under EC exposure. This mechanism, based on the introduction of methyl groups on cytosine's in CpG islands, is carried out by methyltransferases enzymes able to activate this modification in promotor region by influencing regulation process. Several studies demonstrated that methylation pattern is drastically alterated in subjects under EC exposure. To date, several approaches for the early detection of contaminants in biological fluids are under investigation. Liquid biopsy consists in a peripheral blood withdrawn where several biomolecules [cell-free DNA (ccfDNA), circulating tumor cells (CTCs), circulating cell-free RNA (ccfRNA) and exosomes] may be isolated. Students participate to the validation of a LP assay for the evaluation of environmental determinants with the Lab Residents. They assessed the cost-efficacy and the minimally invasive approach in order to construct a reliable model to be exported for the identification of epigenetic changes in the early stage of contamination process in high risk people. The young students role was also to create an informative schedule in order to explain the role and the potential of Liquid biopsy as a non-invasive tool that could allow the analysis of nucleic biomarkers as circulating cell-free DNA (ccfDNA), a potential stable biomarkers of diverse disease conditions in humans and animals.

A green sustainable architectural model for the suburbs

The Goal 11 <<make cities and human settlements inclusive, safe, resilient and sustainable >> is crucial in the increasing Europe urbanization context. By altering cities and the surrounding countryside, urban growth is having several consequences on ecosystem and human health. The urban density alludes to the idea of the cities as a ‘sick bodies', now reemerging because of the recent climatic and health crises. This concept should be contrasted with the idea of the ‘city as a cure', that can limit the consumption of soil and energy, reducing our ecological burden on the environment. Recently, in Europe many urban development projects have been implemented according to sustainability principles as the Eindhoven demonstration case where, a central square was transformed into a small green oasis. Reforesting, even at the cost of demolishing to create large avenues for green area, is essential for air quality and for intervening on the climate. To intervene on abandoned urban canals by creating new waterways may redevelop entire areas and affect traffic and temperature. To contain the negative impact of the built space on the environment is in fact aimed at increasing the green space. However, recent studies demonstrate the criticalities of the fragmentation of landscapeto analyze the link between urban form and landscape heterogeneity to establish renewed relationships between the forms of architecture and the natural void and to devise urban projects to control building density and population. In particular, to develop models for redeveloping the suburbs by building new urban parts from scratch, with a view to urban polycentrism. The recomposition of ecological corridors and of the municipal, provincial and regional environmental network may connect to the great ‘green lungs' of natural parks and to areas with a high degree of naturalness in a progressive succession of habitats to mitigate ever new forms of overall mutations of natural and anthropised environments.

How the harm of drugs and their availability affect brain reactions to drug cues: a meta-analysis of 64 neuroimaging activation studies

Visual drug cues are powerful triggers of craving in drug abusers contributing to enduring addiction. According to previous qualitative reviews, the response of the orbitofrontal cortex to such cues is sensitive to whether subjects are seeking treatment. Here we re-evaluate this proposal and assessed whether the nature of the drug matters. To this end, we performed a quantitative meta-analysis of 64 neuroimaging studies on drug-cue reactivity across legal (nicotine, alcohol) or illegal substances (cocaine, heroin). We used the ALE algorithm and a hierarchical clustering analysis followed by a cluster composition statistical analysis to assess the association of brain clusters with the nature of the substance, treatment status, and their interaction. Visual drug cues activate the mesocorticolimbic system and more so in abusers of illegal substances, suggesting that the illegal substances considered induce a deeper sensitization of the reward circuitry. Treatment status had a different modulatory role for legal and illegal substance abusers in anterior cingulate and orbitofrontal areas involved in inter-temporal decision making. The class of the substance and the treatment status are crucial and interacting factors that modulate the neural reactivity to drug cues. The orbitofrontal cortex is not sensitive to the treatment status per se, rather to the interaction of these factors. We discuss that these varying effects might be mediated by internal predispositions such as the intention to quit from drugs and external contingencies such as the daily life environmental availability of the drugs, the ease of getting them and the time frame of potential reward through drug consumption.

Ferrous iron- and ammonium-rich diffuse vents support habitat-specific communities in a shallow hydrothermal field off the Basiluzzo Islet (Aeolian Volcanic Archipelago)

Ammonium- and Fe(II)-rich fluid flows, known from deep-sea hydrothermal systems, have been extensively studied in the last decades and are considered as sites with high microbial diversity and activity. Their shallow-submarine counterparts, despite their easier accessibility, have so far been under-investigated, and as a consequence, much less is known about microbial communities inhabiting these ecosystems. A field of shallow expulsion of hydrothermal fluids has been discovered at depths of 170-400 meters off the base of the Basiluzzo Islet (Aeolian Volcanic Archipelago, Southern Tyrrhenian Sea). This area consists predominantly of both actively diffusing and inactive 1-3 meters-high structures in the form of vertical pinnacles, steeples and mounds covered by a thick orange to brown crust deposits hosting rich benthic fauna. Integrated morphological, mineralogical, and geochemical analyses revealed that, above all, these crusts are formed by ferrihydrite-type Fe³⁺ oxyhydroxides. Two cruises in 2013 allowed us to monitor and sampled this novel ecosystem, certainly interesting in terms of shallow-water iron-rich site. The main objective of this work was to characterize the composition of extant communities of iron microbial mats in relation to the environmental setting and the observed patterns of macrofaunal colonization. We demonstrated that iron-rich deposits contain complex and stratified microbial communities with a high proportion of prokaryotes akin to ammonium- and iron-oxidizing chemoautotrophs, belonging to Thaumarchaeota, Nitrospira, and Zetaproteobacteria. Colonizers of iron-rich mounds, while composed of the common macrobenthic grazers, predators, filter-feeders, and tube-dwellers with no representatives of vent endemic fauna, differed from the surrounding populations. Thus, it is very likely that reduced electron donors (Fe²⁺ and NH₄⁺ ) are important energy sources in supporting primary production in microbial mats, which form a habitat-specific trophic base of the whole Basiluzzo hydrothermal ecosystem, including macrobenthic fauna.

A longitudinal conventional and magnetization transfer magnetic resonance imaging study of optic neuritis

Eleven consecutive patients with a first episode of acute optic neuritis were evaluated, using conventional and magnetization transfer (MT) magnetic resonance imaging (MRI), in order to assess the temporal evolution of optic nerve (ON) damage and to investigate the correlation of ON damage with visual outcome and electrophysiological parameters. Patients underwent neuro-ophthalmological, neurological, electrophysiological, and MRI assessments at baseline and after three and 12 months. ON volumes were measured on coronal T1–weighted images using a local thresholding segmentation technique. MT ratio (MTR) from the ON was derived from gradient echo images. No significant volume difference was detected between affected and healthy ON, both at baseline and follow-up. At baseline, mean MTR values were significantly higher in affected ON than in healthy ON (P = 0.001), whereas at months 3 and 12, the mean MTR values were significantly reduced in the affected ON (P = 0.02 and 0.003, respectively). Mean MTR of the affected ON, corrected for healthy ON values, progressively decreased over time (P = 0.04 at month 3 and P = 0.0012 at month 12). On the contrary, MTR values of healthy ON remained stable. No correlations were found between MTR measures and clinical or electrophysiological data. This study shows the presence of subtle pathological changes, possibly due to residual demyelination and subsequent additional demyelination and impaired remyelination, in the ON of patients with a first episode of optic neuritis. In the early phase of optic neuritis, MT MRI is more sensitive than atrophy measurements in detecting disease-related changes. Multiple Sclerosis 2007; 13: 265–268. http://msj.sagepub.com

Valutazione della sicurezza ed efficacia di iodixanolo 270 mgI/ml e 320mgI/ml a confronto con iopamidolo 300 mgI/ml nella TC cerebrale

Scopo di questo studio doppio cieco, randomizzato, comparativo a tre gruppi paralleli, è stato il confronto della sicurezza tollerabilità ed efficacia della concentrazione più bassa (270 mgI/ml: 39 pazienti) e più alta (320 mgI/ml: 39 pazienti) di iodixanolo (Visipaque ®), un nuovo mezzo di contrasto iodato non-ionico dimero, con iopamidolo (300 mgI/ml: 40 pazienti) nell'esame di tomografia computerizzata della testa. Le caratteristiche generali dei pazienti risultarono simili nei 3 gruppi di trattamento. Nessuna differenza significativa (p > 0,05) fu riscontrata tra i 3 gruppi di trattamento nella informazione diagnostica, il principale parametro di efficacia (ottimale in 37, 36 e 39 pazienti del gruppo iodixanolo 270, iodixanolo 320 e iopamidolo 300 rispettivamente). I risultati riguardanti la sicurezza non mostrarono nessuna differenza significativa tra i 3 mezzi di contrasto considerati. Su 118 pazienti, 9 accusarono discomfort (7%, 5%, e 10% nel gruppo iodixanolo 270, iodixanolo 320 e iopamidolo 300 rispettivamente) e solo 1 pz. del gruppo iodixanolo 320 mgI/ml presentò un evento avverso diverso dal discomfort (transitoria e lieve nausea, tosse, e dispnea). Il test esatto di Fisher dette p = 0,50 nel confronto tra gruppo iodixanolo 320 e gruppo iopamidolo 300.

In conclusione, iodixanolo 270 mgI/ml e 320 mgI/ml risultarono mezzi di contrasto sicuri ed efficaci nell'esame di tomografia computerizzata della testa, e non fu riscontrata nessuna differenza significativa nella sicurezza ed efficacia rispetto a iopamidolo 300 mgI/ml.

Trattamento endovascolare degli aneurismi intracranici con spirali staccabili (GDC)

Tra Giugno 1993 e Agosto 1994, sono stati trattati con spirali staccabili di Guglielmi 32 pazienti con aneurismi intracranici subaracnoidei. Il gruppo è composto da 24 femmine e 8 maschi, con età media di 53 anni.

Venti pazienti sono stati trattati in fase acuta a seguito di emorragia subaracnoidea; 12 sono stati diagnosticati per la presenza di segni neurologici legati alla sede e dimensione dell'aneurisma (effetto massa, deficit di nervi cranici), o sono stati un riscontro occasionale.

Per quanto riguarda le dimensioni, 15 aneurismi erano piccoli (meno di 10 mm di diametro), 11 erano grandi (fra 10 e 25 mm di diametro) e 6 erano giganti (più di 25 mm di diametro, comprendendo la porzione eventualmente trombizzata).

Un elemento importante nel condizionare le probabilità di successo del trattamento endovascolare è rappresentato dalle dimensioni del colletto in rapporto alle dimensioni dell'aneurisma: 14 aneurismi avevano un colletto di diametro inferiore ai 4 mm (10 piccoli, 3 grandi e un gigante) e 12 un colletto di diametro superiore ai 4 mm (3 piccoli, 5 grandi e 4 giganti); negli altri 6 non è stata possibile una valutazione sufficientemente accurata.

Gli aneurismi del circolo posteriore erano 11, 8 dell'apice e 3 del tronco della basilare.

Tutti i pazienti sono stati trattati in anestesia generale; gli ultimi 22 pazienti erano in eparinizzazione totale.

I controlli a distanza sono disponibili solo per un numero limitato di pazienti (3 a 12 mesi; 5 a 6 mesi e 2 a 4 mesi); tutti i pazienti hanno avuto un controllo angiografico immediato e ad una settimana dal trattamento. Secondo il protocollo tutti i pazienti avranno un controllo angiografico ad un anno e possibilmente a 24 mesi dal trattamento.

Il controllo angiografico ha mostrato occlusione completa dell'aneurisma in 18 pazienti (56%), occlusione parziale in dodici (38%) (di cui in 6 superiore all '80%). In due pazienti (6%) non è stato possibile posizionare il microcatetere Tracker all'interno dell'aneurisma. Questi due pazienti sono stati successivamente operati, come altri due in cui non era stato possibile posizionare un numero di coils adeguato per ottenere un packing soddisfacente ed era residuato un colletto non protetto.

Tre pazienti sono stati trattati due volte; in due il trattamento è stato ripetuto perchè un controllo a 6 mesi aveva documentato ricanalizzazione parziale dell'aneurisma, nel terzo perchè il posizionamento delle coils era stato interrotto la prima volta per il riscontro di embolo nella arteria cerebrale media.

Non si sono rilevate differenze nella percentuale di occlusione in funzione della sede dell'aneurisma; per quanto riguarda le dimensioni, la percentuale di occlusione completa e del 33% negli aneurismi giganti, del 63% in quelli grandi e del 70% in quelli piccoli.

Nella nostra casistica il diametro del colletto non sembra influenzare in maniera significativa la percentuale di chiusura completa; ciò può essere tuttavia espressione del numero per ora basso di aneurismi trattati.

Sui 14 aneurismi con colletto piccolo si è avuta chiusura completa in 5 dei 10 piccoli, vale a dire solo il 50%. Tuttavia in due pazienti non e stato possibile introdurre le spirali nell'aneurisma e si tratta quindi di insuccessi tecnici. Se quindi si considerano 8 aneurismi trattati la percentuale sale al 62%. Tutti i tre aneurismi grandi sono stati occlusi completamente (100%) mentre la chiusura dell'unico aneurisma gigante è stata parziale.

Nei 12 aneurismi con colletto di diametro superiore ai 4 mm, 2 su 3 piccoli sono stati chiusi completamente (66%), 3 su 5 grandi (60%) e 1 su 4 giganti (25%).

Nessun paziente è morto in conseguenza diretta del trattamento; due pazienti, entrambi con emorragia subaracnoidea di grado 3–4 sono morti cinque giorni dopo il trattamento. Si trattava di aneurismi della comunicante anteriore, in un caso associato a spasmo della cerebrale anteriore con successivo infarto frontale e nell'altro con ematoma frontobasale mesiale, prodottosi dopo il posizionamento delle coils.

Si sono registrate 5 complicanze emboliche (15%) durante il trattamento o nelle prime dodici ore successive; tutte tranne una in pazienti non eparinizzati. Quattro delle complicanze sono state sintomatiche con deficit neurologici residui in 3 pazienti, da lieve afasia a grave emiparesi.

In un paziente si è prodotta rottura dell'aneurisma nel corso del posizionamento delle coils, per eccessivo avanzamento del Tracker dopo la quarta coil. Il posizionamento di una quinta coil ha conseguito il tamponamento della rottura.

In totale sono state impiegate 155 spirali con una media di cinque spirali per paziente; questo alto numero è spiegato dalla prevalenza, nel nostro gruppo, di aneurismi grandi o giganti.

La Neuroradiologia Terapeutica: Valutazione del rapporto costi-benefici

In vista del possibile cambiamento del sistema di pagamento delle prestazioni sanitarie, con il passaggio dalla attuale forma di contabilizzazione delle giornate di degenza a quella di rimborso per caso trattato (in analogia con i DRG americani), diventa fondamentale conoscere con precisione i costi reali delle singole procedure e dei singoli trattamenti.

Questo articolo analizza esclusivamente i costi di alcune delle più comuni procedure di Neuroradiologia Terapeutica Endovascolare, attraverso una valutazione analitica dei prezzi dei materiali di consumo, dei costi del personale coinvolto e delle attrezzature.

Viene analizzato il costo delle seguenti procedure:

angiografia diagnostica, primo tempo indispensabile per qualunque procedura di terapia endovascolare; angioplastica della succlavia; trattamento endovascolare degli aneurismi intracranici con spirali staccabili (GDC); trattamento endovascolare delle malformazioni arterovenose cerebrali.

Di particolare interesse nei risultati è il riscontro che i costi fissi, vale a dire ammortamento e manutenzione delle attrezzature, incidono per una percentuale variabile che oscilla fra il 6,4% per il trattamento degli aneurismi con spirali staccabili (GDC) e il 45,7% per l'angiografia diagnostica. Ciò per l'alto costo dei materiali di consumo, in particolare le spirali, nel trattamento degli aneurismi. Il costo del personale oscilla frail 6 e il 15%. Il costo di una angiografia diagnostica, intorno ad un milione e settecentomila lire, è superiore alle attuali cifre di rimborso del nomenclatore tariffario. Il costo per un trattamento di angioplastica della succlavia e intorno ai 3 milioni mentre quello di un aneurisma intracranico di piccole dimensioni, che richieda l'impiego di una sola spirale, è intorno ai 7 milioni.

Verranno in un prossimo articolo presi in considerazione i costi degli interventi chirurgici per patologie equivalenti e verrà quindi effettuata una valutazione comparativa, includendo la durata e il costo del periodo di degenza.

Emotional reactivity in chronic schizophrenia: structural and functional brain correlates and the influence of adverse childhood experiences

BACKGROUND

Despite behavioural signs of flattened affect, patients affected by schizophrenia show enhanced sensitivity to negative stimuli. The current literature concerning neural circuitry for emotions supports dysregulations of cortico-limbic networks, but gives contrasting results. Adverse childhood experiences (ACEs) could persistently influence emotional regulation and neural correlates of response to emotional stimuli in healthy humans. This study evaluated the effect of ACEs and chronic undifferentiated schizophrenia on neural responses to emotional stimuli (negative facial expression).

METHOD

Brain blood-oxygen-level-dependent functional magnetic resonance imaging neural responses to a face-matching paradigm, and regional grey matter (GM) volumes were studied at 3.0 T in the amygdala, hippocampus, anterior cingulated cortex (ACC) and prefrontal cortex (PFC). The severity of ACEs was assessed. Participants included 20 consecutively admitted in-patients affected by chronic undifferentiated schizophrenia, and 20 unrelated healthy volunteers from the general population.

RESULTS

Patients reported higher ACEs than controls. Worse ACEs proportionally led to decreasing responses in the amygdala and hippocampus, and to increasing responses in the PFC and ACC in all participants. Patients showed higher activations in the amygdala and hippocampus, and lower activations in the PFC and ACC. Higher ACEs were associated with higher GM volumes in the PFC and ACC, and schizophrenia was associated with GM reduction in all studied regions.

CONCLUSIONS

Structural and functional brain correlates of emotional reactivity are influenced by both current chronic undifferentiated schizophrenia and the severity of past ACEs.

Temporal lobe grey matter volume in schizophrenia is associated with a genetic polymorphism influencing glycogen synthase kinase 3-β activity

At the crossroad of multiple pathways regulating trophism and metabolism, glycogen synthase kinase (GSK)3 is considered a key factor in influencing the susceptibility of neurons to harmful stimuli (neuronal resilience) and is a target for several psychiatric drugs that directly inhibit it or increase its inhibitory phosphorylation. Inhibition of GSK3 prevents apoptosis and could protect against the neuropathological processes associated with psychiatric disorders. A GSK3-beta promoter single-nucleotide polymorphism (rs334558) influences transcriptional strength, and the less active form was associated with less detrimental clinical features of mood disorders. Here we studied the effect of rs334558 on grey matter volumes (voxel-based morphometry) of 57 patients affected by chronic schizophrenia. Carriers of the less active C allele variant showed significantly higher brain volumes in an area encompassing posterior regions of right middle and superior temporal gyrus, within the boundaries of Brodmann area 21. The temporal lobe is the brain parenchymal region with the most consistently documented morphometric abnormalities in schizophrenia, and neuropathological processes in these regions develop soon at the beginning of the illness. These results support the interest for GSK3-beta as a factor affecting neuropathology in major behavioural disorders, such as schizophrenia, and thus as a possible target for treatment.

Follow-up of coiled cerebral aneurysms at 3T: comparison of 3D time-of-flight MR angiography and contrast-enhanced MR angiography

BACKGROUND AND PURPOSE

Our aim was to compare contrast-enhanced MR angiography (CE-MRA) and 3D time-of-flight (TOF) MRA at 3T for follow-up of coiled cerebral aneurysms.

MATERIALS AND METHODS

Fifty-two patients treated with Guglielmi detachable coils for 54 cerebral aneurysms were evaluated at 3T MRA. 3D TOF MRA (TR/TE = 23/3.5; SENSE factor = 2.5) and CE-MRA by using a 3D ultrafast gradient-echo sequence (TR/TE = 5.9/1.8; SENSE factor = 3) enhanced with 0.1-mmol/kg gadobenate dimeglumine were performed in the same session. Source images, 3D maximum intensity projection, 3D shaded surface display, and/or 3D volume-rendered reconstructions were evaluated in terms of aneurysm occlusion/patency and artifact presence.

RESULTS

In terms of clinical classification, the 2 MRA sequences were equivalent for 53 of the 54 treated aneurysms: 21 were considered fully occluded, whereas 16 were considered to have a residual neck and 16 were considered residually patent at follow-up MRA. The remaining aneurysm appeared fully occluded at TOF MRA but had a residual patent neck at CE-MRA. Visualization of residual aneurysm patency was significantly (P = .001) better with CE-MRA compared with TOF MRA for 10 (31.3%) of the 32 treated aneurysms considered residually patent with both sequences. Coil artifacts were present in 5 cases at TOF MRA but in none at CE-MRA. No relationship was apparent between the visualization of patency and either the size of the aneurysm or the interval between embolization and follow-up.

CONCLUSION

At follow-up MRA at 3T, unenhanced TOF and CE-MRA sequences are similarly effective at classifying coiled aneurysms as occluded or residually patent. However, CE-MRA is superior to TOF MRA for visualization of residual patency and is associated with fewer artifacts.

Altered functional and structural connectivities in patients with MS: a 3-T study

OBJECTIVE

To determine the functional and structural substrates of motor network dysfunction in patients with relapsing-remitting multiple sclerosis (RRMS).

METHODS

Using a 3-T scanner, in 12 right-handed RRMS patients and 14 matched controls, we acquired diffusion tensor (DT) MRI and functional MRI during the performance of a simple motor task with the right (R) hand. Using DT MRI tractography, we calculated DT-derived metrics from several motor and nonmotor white matter (WM) fiber bundles. Functional connectivity analysis was performed using SPM2.

RESULTS

Compared with control, MS patients had abnormal DT MRI metrics of all the WM bundles studied. Compared with controls, MS patients had more significant activations of the left (L) supplementary motor area (SMA), the L primary sensorimotor cortex (SMC), and the R cerebellum. They also had increased functional connectivity between the R primary SMC and the R cerebellum (p = 0.01) and the L SMA and the L primary SMC (p = 0.04). Coefficients of altered connectivity were correlated with structural MRI metrics of tissue damage of the corticospinal and the dentatorubrothalamic tract (r values ranging from -0.73 to 0.85).

CONCLUSIONS

The correlations found between measures of functional connectivity and structural damage to some of the major brain motor white matter bundles suggest an adaptive role of functional connectivity changes in limiting the clinical consequences of structural damage in patients with relapsing-remitting multiple sclerosis. Combining measures of altered functional and structural connectivities of specific brain networks is a promising tool to elucidate the mechanisms responsible for clinical manifestations of CNS damage.

Clock genes beyond the clock: CLOCK genotype biases neural correlates of moral valence decision in depressed patients

Gene polymorphisms in the mammalian biological clock system influence individual rhythms. A single nucleotide polymorphism (SNP) in the 3' flanking region of CLOCK (3111 T/C; rs1801260) influenced diurnal preference in healthy humans and caused sleep phase delay and insomnia in patients affected by bipolar disorder. Genes of the biological clock are expressed in many brain structures other than in the 'master clock' suprachiasmatic nuclei. These areas, such as cingulate cortex, are involved in the control of many human behaviors. Clock genes could then bias 'nonclock' functions such as information processing and decision making. Thirty inpatients affected by a major depressive episode underwent blood oxygen-level dependent (BOLD) functional magnetic resonance imaging (fMRI). The cognitive activation paradigm was based on a go/no-go task. Morally connoted words were presented. Genotyping of CLOCK was performed for each patients. We measured activity levels through actimetry during the day before the fMRI study. CLOCK 3111 T/C SNP was associated with activity levels in the second part of the day, neuropsychological performance and BOLD fMRI correlates (interaction of genotype and moral valence of the stimuli). Our results support the hypothesis that individual clock genotype may influence several variables linked with human behaviors in normal and psychopathological conditions.

A Deconvolution Approach Based on Multi-Tensor Model to Solve Fiber Crossing in Diffusion-MRI

A deconvolution approach, based on a multi-tensor model, is presented to solve fiber crossing in diffusion MRI. In order to provide a direct physical interpretation of the signal generation process, we re-wrote the classical multi-tensor model, identifying a significant scalar parameter alpha to characterize the deconvolution process. Simulations show that, in presence of noise, the method is able to correctly separate fiber crossing. Application on in-vivo data highlights the ability of our approach to distinguish more than two fibers within the same voxel, suggesting its application in fiber tracking or connectivity studies even of complex brain structures.

The contribution of voxel-based morphometry in staging patients with mild cognitive impairment

OBJECTIVE

To assess whether different patterns of regional gray matter loss in patients with mild cognitive impairment (MCI) are associated with different risks of conversion to Alzheimer disease (AD), using MRI and voxel-based morphometry (VBM).

METHODS

The authors recruited 22 patients with MCI, 22 patients with probable AD, and 20 healthy subjects (HS). T1 volumes from each subject were postprocessed according to an optimized VBM protocol. All patients were clinically followed up (mean [SD] time = 28.7 [5.7] months), and patients with MCI were reclassified into two groups (converters and nonconverters to AD).

RESULTS

When comparing patients with AD to HS, widespread areas of reduced gray matter density were found predominantly in temporal, frontal, and parietal lobes and in the insula. Comparing MCI converters and nonconverters with HS, the converters showed more widespread areas of reduced gray matter density than nonconverters, with a pattern of abnormalities similar to that seen in patients with AD. Conversely, when comparing the same groups with patients with AD, MCI nonconverters showed a pattern of gray matter density similar to that of HS. Areas of decreased gray matter density were also found in MCI converters compared with nonconverters.

CONCLUSIONS

Different patterns of gray matter density distribution in patients with mild cognitive impairment may be associated to different rates of conversion to Alzheimer disease.

Diffusion tensor magnetic resonance imaging at 3.0 tesla shows subtle cerebral grey matter abnormalities in patients with migraine

BACKGROUND AND OBJECTIVE

Diffusion tensor (DT) magnetic resonance imaging (MRI) has the potential to disclose subtle abnormalities in the brain of migraine patients. This ability may be increased by the use of high field magnets. A DT MRI on a 3.0 tesla scanner was used to measure the extent of tissue damage of the brain normal appearing white (NAWM) and grey matter in migraine patients with T2 visible abnormalities.

METHODS

Dual echo, T1 weighted and DT MRI with diffusion gradients applied in 32 non-collinear directions were acquired from 16 patients with migraine and 15 sex and age matched controls. Lesion load on T2 weighted images was measured using a local thresholding segmentation technique, and brain atrophy assessed on T1 weighted images using SIENAx. Mean diffusivity and fractional anisotropy histograms of the NAWM and mean diffusivity histograms of the grey matter were also derived.

RESULTS

Brain atrophy did not differ between controls and patients. Compared with healthy subjects, migraine patients had significantly reduced mean diffusivity histogram peak height of the grey matter (p=0.04). No diffusion changes were detected in patients' NAWM. In migraine patients, no correlation was found between T2 weighted lesion load and brain DT histogram derived metrics, whereas age was significantly correlated with grey matter mean diffusivity histogram peak height (p=0.05, r=-0.52).

CONCLUSIONS

DT MRI at high field strength discloses subtle grey matter damage in migraine patients, which might be associated with cognitive changes in these patients.

Angiographic follow-up of cerebral aneurysms treated with Guglielmi detachable coils: an analysis of 162 cases with 173 aneurysms

BACKGROUND AND PURPOSE

The endovascular approach, with the use of Guglielmi detachable coils (GDC), has been increasingly used to treat ruptured and unruptured cerebral aneurysms in recent years. Our objective was to assess the mid- to long-term radiologic outcome of cerebral aneurysms treated with GDC embolization.

METHODS

One hundred and sixty-two patients with a total of 173 aneurysms embolized with GDCs underwent angiographic follow-up 1 to 54 months after the procedure and were reviewed retrospectively. Each angiogram was reviewed by 2 neuroradiologists and 1 neurosurgeon, each of whom made a comparison between the initial and follow-up angiograms. Morphologic outcomes were scored as follows: unchanged, progressive thrombosis, and reopening or regrowth.

RESULTS

Of the 173 aneurysms with GDC embolization, 142 had total or nearly total occlusion, 23 subtotal occlusion, and 8 partial occlusion on the initial angiograms. The incidence of reopening was 17.1% (13/76) in less than 3 months and 6.2% (6/97) between 3 and 6 months after the procedure. Four aneurysms (2.3%) were found to be recurrent in the second follow-up angiography within 1 year after the procedure. The 1-year cumulative recurrent rate was 13.3%. Among 56 aneurysms with a third follow-up angiography in the period of 12 to 54 months after the procedure, 4 (7.1%) displayed a slight enlargement; the long-term cumulative recurrent rate was 20.4%.

CONCLUSION

The direct and primary causes for aneurysmal recurrence are incomplete and loose packing. The first angiographic follow-up is recommended to be performed at 3 months or earlier for incompletely occluded aneurysms and at 6 months for totally or nearly totally occluded aneurysms. In case of total or nearly total occlusion that remains stable at follow-up, the interval for monitoring should be prolonged appropriately. Retreatment with balloon- or stent-assisted coil embolization is recommended for reopened aneurysms.

A whole brain MR spectroscopy study from patients with Alzheimer's disease and mild cognitive impairment

Brain damage in Alzheimer's disease (AD) and mild cognitive impairment (MCI) is widespread with involvement of large portions of the neocortex and the subcortical white matter. A quantitative measure of neuronal damage of the entire brain might be valuable in the context of large-scale, longitudinal studies of these patients. This study investigated the extent of neuroaxonal injury of patients with AD and MCI using a novel unlocalized proton magnetic resonance spectroscopy ((1)H-MRS) technique, which allows quantification of the concentration of N-acetylaspartate from the whole of the brain tissue (WBNAA). Conventional brain MRI and WBNAA were obtained from 28 AD patients, 27 MCI patients and 25 age-matched controls. Normalized brain volume (NBV) was also measured using an automated segmentation technique. WBNAA and NBV showed a significant heterogeneity between groups (P < 0.001). WBNAA concentration was different between controls and MCI patients (P = 0.003), but not between MCI and AD patients (P = 0.33). NBV differed both between controls and MCI patients (P = 0.02) and between MCI and AD patients (P = 0.03). A multivariate regression model retained WBNAA as the best MRI predictor of the Mini Mental State Examination score (P = 0.001). Significant neuronal damage, which is related to the extent of cognitive decline, can be quantified in the whole brain tissue of patients with AD, using a novel (1)H-MRS approach. The demonstration in patients with MCI of MR structural and metabolic findings, intermediate between those of healthy volunteers and those of AD patients, indicates that neuronal damage is already evident and widespread in individuals with MCI before they are clinically demented.

Brain tissue damage in dementia with Lewy bodies: an in vivo diffusion tensor MRI study

The aim of the present study was to apply diffusion tensor MRI (DT-MRI), a quantitative MRI measure which reflects tissue organization, to dementia with Lewy bodies (DLB). DT-MRI scans were obtained from 15 patients with probable DLB and 10 sex- and age-matched healthy controls. Abnormalities were found in the corpus callosum, pericallosal areas and the frontal, parietal, occipital and, less prominently, temporal white matter of patients compared with controls. Abnormalities were also found in the caudate nucleus and the putamen. The average grey matter volume was lower in patients than in controls. These findings of concomitant grey matter atrophy and white matter abnormalities (as detected by DT-MRI) in regions with a high prevalence of long connecting fibre tracts might suggest the presence of neurodegeneration involving associative cortices. The modest involvement of the temporal lobe fits with the relative preservation of global neuropsychological measures and memory tasks in the early stage of DLB. The selective involvement of parietal, frontal and occipital lobes might explain some of the clinical and neuropsychological features of DLB, providing a possible distinctive marker for this disease. The abnormalities found in the subcortical grey matter may indicate that DLB and Parkinson's disease share a similar nigrostriatal involvement caused by common pathophysiological mechanisms.

A functional MRI study of movement-associated cortical changes in patients with Devic's neuromyelitis optica

Movement-associated cortical changes have been shown in several neurological conditions and were found to be associated to the extent of brain and cord damage. Devic's neuromyelitis optica (DNO) is characterized by a severe involvement of the cord and optic nerve, with sparing of the brain. To assess the actual role of cord pathology on the pattern of movement-associated cortical recruitment, we obtained functional magnetic resonance imaging (fMRI) from patients with DNO and investigated whether the extent of brain activation is correlated with the extent of cervical cord damage. We studied 10 right-handed DNO patients and 15 sex- and age-matched healthy controls. The MRI assessment consisted of the following: (a) fMRI during repetitive flexion extension of the last four fingers of the right and left hand, (b) brain and cervical cord conventional MRI, and (c) cervical cord magnetization transfer (MT) MRI. Compared to controls and for both tasks, DNO patients had an increased recruitment of several regions of the sensorimotor network (primary sensorimotor cortex, postcentral gyrus, middle frontal gyrus, rolandic operculum, secondary sensorimotor cortex, precuneus, and cerebellum) and of several other regions mainly in the temporal and occipital lobes, such as MT/V5, the fusiform gyrus, the cuneus, and the parahippocampal gyrus. For both tasks, strong correlations (r values ranging from -0.76 to -0.85) were found between relative activations of cortical sensorimotor areas and the severity of cervical cord damage. This study shows an abnormal pattern of movement-associated cortical activations in patients with DNO, which extends beyond the 'classical' sensorimotor network and also involves visual areas devoted to motion processing. The correlation found between fMRI changes and the extent of cord damage suggests that such functional cortical changes might have an adaptive role in limiting the clinical outcome of DNO structural pathology.

Cord damage elicits brain functional reorganization after a single episode of myelitis

OBJECTIVE

To assess, using fMRI, the brain pattern of movement-associated cortical activations in patients with a previous remitting episode of acute cervical myelitis of possible demyelinating origin and to investigate whether the extent of cortical reorganization is associated with the extent of cervical cord pathology measured using magnetization transfer (MT) MRI.

METHODS

From 14 right-handed patients in a chronic and stable phase after an isolated myelitis (male/female = 7/7, mean age = 35.3 years, median disease duration = 21.2 months) involving the cervical cord and 15 sex- and age-matched healthy control subjects, we obtained 1) fMRI during repetitive flexion-extension of the last four fingers of the right hand, 2) brain diffusion tensor MRI, and 3) brain and cervical cord conventional and MT MRI. FMRI data were analyzed using Statistical Parametric Mapping software. Brain mean diffusivity, fractional anisotropy, and MT ratio (MTR) histograms of the normal-appearing white and gray matter and cervical cord MTR histograms were produced.

RESULTS

Patients with myelitis had lower average cord MTR (p < 0.0001) and cord MTR histogram peak position (p = 0.002) than control subjects. Compared with healthy volunteers, patients with myelitis showed increased recruitment of the ipsilateral hemisphere in the primary sensorimotor cortex (p < 0.0001), supplementary motor area (p = 0.002), and middle frontal gyrus (MFG) (p < 0.0001). Average cervical cord MTR was inversely correlated with relative activations of the ipsilateral MFG (r = -0.80) and of the ipsilateral postcentral gyrus (r = -0.80). The relative activation of the ipsilateral MFG was also correlated with cervical cord MTR peak position (r = -0.92).

CONCLUSIONS

An abnormal pattern of movement-associated cortical activations was found in patients with a previous episode of cervical myelitis. These functional cortical changes might have an adaptive role in limiting the clinical outcome of structural cord damage.

Evidence for widespread axonal damage at the earliest clinical stage of multiple sclerosis

Although axonal pathology is recognized as one of the major pathological features of multiple sclerosis, it is less clear how early in its course it occurs and how it correlates with MRI-visible lesion loads. To assess this early axonal pathology, we quantified the concentration of whole-brain N-acetylaspartate (WBNAA) in a group of patients at the earliest clinical stage of the disease and compared the results with those from healthy controls. Conventional brain MRI and WBNAA using unlocalized proton magnetic resonance spectroscopy were obtained from 31 patients at presentation with clinically isolated syndromes suggestive of multiple sclerosis and paraclinical evidence of dissemination in space, and from 16 matched controls. An additional conventional MRI scan was obtained in all patients 4-6 months later to detect dissemination of lesions in time. The mean WBNAA concentration was significantly lower in patients compared with the controls (P < 0.0001). It was not significantly different between patients with and without enhancing lesions at the baseline MRI or between patients with and without lesion dissemination in time. No correlation was found between WBNAA concentrations and lesion volumes. Widespread axonal pathology, largely independent of MRI-visible inflammation and too extensive to be completely reversible, occurs in patients even at the earliest clinical stage of multiple sclerosis. This finding lessens the validity of the current concept that the axonal pathology of multiple sclerosis is the end-stage result of repeated inflammatory events, and argues strongly in favour of early neuroprotective intervention.

Magnetic resonance diffusion-weighted images in Creutzfeldt-Jakob disease: case report

We describe the diffusion-weighted MRI findings and follow-up in a case of autopsy-proven Creutzfeldt-Jakob disease that revealed abnormal hyperintensity in the cortex and basal ganglia.

White matter damage in Alzheimer's disease assessed in vivo using diffusion tensor magnetic resonance imaging

OBJECTIVE

To investigate the extent and the nature of white matter tissue damage of patients with Alzheimer's disease using diffusion tensor magnetic resonance imaging (DT-MRI).

BACKGROUND

Although Alzheimer's disease pathology mainly affects cortical grey matter, previous pathological and MRI studies showed that also the brain white matter of patients is damaged. However, the nature of Alzheimer's disease associated white matter damage is still unclear.

METHODS

Conventional and DT-MRI scans were obtained from 16 patients with Alzheimer's disease and 10 sex and age matched healthy volunteers. The mean diffusivity (D), fractional anisotropy (FA), and inter-voxel coherence (C) of several white matter regions were measured.

RESULTS

D was higher and FA lower in the corpus callosum, as well as in the white matter of the frontal, temporal, and parietal lobes from patients with Alzheimer's disease than in the corresponding regions from healthy controls. D and FA of the white matter of the occipital lobe and internal capsule were not different between patients and controls. C values were also not different between patients and controls for any of the regions studied. Strong correlations were found between the mini mental state examination score and the average overall white matter D (r=0.92, p<0.001) and FA (r=0.78; p<0.001).

CONCLUSIONS

White matter changes in patients with Alzheimer's disease are likely to be secondary to wallerian degeneration of fibre tracts due to neuronal loss in cortical associative areas.

Evidence for widespread movement-associated functional MRI changes in patients with PPMS

BACKGROUND

Previous work has suggested that functional reorganization of cortical motor areas might have a role in limiting the motor deficits in patients with MS.

OBJECTIVE

To test whether movement-associated cortical changes in MS might extend beyond the "classic" motor areas and involve sites for multimodal integration.

METHODS

fMRI was used to assess patterns of brain activations associated with 3 different motor tasks in 30 right-handed patients with primary progressive MS (PPMS) and variable degrees of motor impairment, which were compared with those from 15 right-handed, sex- and age-matched control subjects.

RESULTS

Compared with control subjects, patients with MS showed increased activation of brain regions within both traditional motor planning and execution regions (including the supplementary motor area and the cingulate motor area), the insula (a region implicated in sensory processing), and several multimodal cortical regions in the temporal, parietal, and occipital lobes. In patients, the extent of the fMRI activations was strongly correlated with MR lesion burden (r ranging from 0.70 to 0.86, p < 0.001).

CONCLUSIONS

This study shows that movement-associated cortical activation in patients with PPMS is widely distributed and also involves multimodal "nonmotor" cortical networks. It also suggests that adaptive cortical reorganization might be one of the mechanisms limiting the clinical impact of MS in the progressive phases of the disease.

Functional magnetic resonance imaging correlates of fatigue in multiple sclerosis

Although fatigue is a common and troublesome symptom of multiple sclerosis (MS), its pathogenesis is poorly understood. In this study, we used functional magnetic resonance imaging (fMRI) to test whether a different pattern of movement-associated cortical and subcortical activations might contribute to the development of fatigue in patients with MS. We obtained fMRI during the execution of a simple motor task with completely normally functioning hands from 15 MS patients with fatigue (F), 14 MS patients without fatigue (NF), and 15 sex- and age-matched healthy volunteers. F and NF MS patients were also matched for major clinical and MRI variables. FMRI data were analyzed using statistical parametric mapping. In all patients, severity of fatigue was rated using the Fatigue Severity Scale (FSS). Compared to healthy subjects, MS patients showed more significant activations of the contralateral primary somatomotor cortex, the contralateral ascending limb of the Sylvian fissure, the contralateral intraparietal sulcus (IPS), the contralateral supplementary motor area, and the ipsilateral and contralateral cingulate motor area (CMA). Compared to F MS patients, NF patients showed more significant activations of the ipsilateral cerebellar hemisphere, the ipsilateral rolandic operculum, the ipsilateral precuneus, the contralateral thalamus, and the contralateral middle frontal gyrus. In contrast, F MS patients had a more significant activation of the contralateral CMA. Significant inverse correlations were found between FSS scores and relative activations of the contralateral IPS (r = -0.63), ipsilateral rolandic operculum (r = -0.61), and thalamus (r = -0.62). This study provides additional evidence that fatigue in MS is related to impaired interactions between functionally related cortical and subcortical areas. It also suggests that fMRI might be a valuable tool to monitor the efficacy of treatment aimed at reducing MS-related fatigue.

Correlations between structural CNS damage and functional MRI changes in primary progressive MS

In patients with primary progressive multiple sclerosis (PPMS), we investigated whether brain and cervical cord structural changes in lesions and normal-appearing brain tissue (NABT), measured using conventional, magnetization transfer (MT), and diffusion tensor (DT) MRI, are correlated with movement-associated cortical activations measured using functional magnetic resonance imaging (fMRI). From 26 right-handed PPMS patients and 15 right-handed, sex- and age-matched healthy controls, we obtained: (a) brain and cervical cord dual-echo scans and MT ratio (MTR) maps; (b) brain mean diffusivity (D(-)) maps, and (c) f-MRI (flexion-extension of the last four fingers of the right hand). All PPMS patients had no previous symptoms affecting their right upper limbs, which were functionally normal. Healthy volunteers showed more significant activation in the ipsilateral cerebellar hemisphere than PPMS patients. PPMS patients showed greater activation bilaterally in the superior temporal gyrus, ipsilaterally in the middle frontal gyrus, and, contralaterally in the insula/claustrum. In PPMS patients, moderate to strong correlations (r values ranging from 0.59 to 0.68) were found between relative activations of cortical areas located in a widespread network for sensory-motor and multimodal integration and the severity of structural changes of the NABT (as measured using MT and DT MRI) and the severity of cervical cord damage (as measured using MT MRI). This study shows that the pattern of cortical activation of PPMS patients is different from that of normal controls even when performing a motor task with clinically unaffected limbs. It also suggests that cortical reorganization might be able to limit the consequences of MS injury in the brain and cervical cord.

Differential diagnosis of posterior fossa multiple sclerosis lesions--neuroradiological aspects

Various infratentorial pathological conditions can mimic multiple sclerosis (MS) both clinically and radiologically. We review the inflammatory, vascular, neoplastic and metabolic conditions which show features similar to those of MS on magnetic resonance imaging (MRI). Behcet's disease, Lyme disease, progressive multifocal leukoencephalopathy, neurosarcoidosis, Whipple's disease, listeria rhombencephalitis, Bickerstaff's brainstem encephalitis, vasculitis due to systemic lupus erythematosus, and acute disseminated encephalomyelitis produce inflammatory lesions similar to those of MS in the brainstem and cerebellum. Neoplastic diseases, in particular pontine gliomas and lymphomas, can mimic MS. Vascular ischaemic lesions, either due to infarction produced by occlusion of a major posterior circulation artery or due to small vessel vasculopathy, can lead to posterior fossa lesions. The MRI changes of central pontine myelinolysis can also mimic MS. Diffuse axonal injury, radiation and chemotherapy induce lesions that resemble MS, however the clinical history will exclude these possibilities. Finally, we discuss a few conditions which are similar to MS in clinical presentation but have different MRI appearances, such as brainstem cavernomas, posterior fossa tumoural lesions, aneurysms and vascular loops producing neurovascular conflicts. Analysis of the MRI findings with clinical history and laboratory data helps to narrow down the diagnosis of the infratentorial pathology.

Diagnosis and differential diagnosis of acute transverse myelopathy. The role of neuroradiological investigations and review of the literature

Acute transverse myelopathy (ATM) is a clinical definition of an acute neurologic condition that reflects impairment of spinal cord function. The term "myelopathy" has a different meaning from "myelitis", even if the words are often confused. Both terms indicate spinal cord involvement by some pathological event; but while myelopathy does not imply any etiological factor, myelitis refers to inflammatory diseases of the spinal cord. Acute spinal pathology can be associated with intra-axial or extra-axial lesions; extra-axial spinal pathology, however, has more often a chronic and progressive presentation. In this paper, we discuss primarily intra-axial lesions with attention on the role of neuroradiological investigations in diagnosis and differential diagnosis. Magnetic resonance imaging is the modality of choice for diagnosis; it shows signal abnormalities, usually T2 hyperintensity, focal or extensive, gadolinium enhancement and sometimes cord swelling. Despite its high sensitivity, about 40% of acute transverse myelopathies remain undemonstrated. Concerning etiology (multiple sclerosis (MS), vasculitis, infection, autoimmune disorders) no clearly different and specific patterns have been found; however small multiple enhancing lesions are more suggestive of MS (or lupus) while extensive, multilevel abnormalities reflect vasculitis as in antiphospholipid antibody syndrome.

Quantification of tissue damage in AD using diffusion tensor and magnetization transfer MRI

The authors measured mean diffusivity (D) and magnetization transfer ratio (MTR) of the brain from 18 patients with AD and 16 healthy control subjects. The peak heights of cortical gray matter (cGM) D (p < 0.001) and MTR (p < 0.001) histograms were lower and average cGM D (p < 0.01) higher in patients with AD than in control subjects. A composite MR score based on brain volume and cGM MTR peak height was correlated with patient cognitive impairment (r = 0.65, p = 0.003). This preliminary study presents a novel approach to quantify AD-related tissue damage in-vivo.

Spinal cord involvement in primary angiitis of the central nervous system: a report of two cases

SUMMARY

We report two patients with suspected primary angiitis of the CNS who underwent serial contrast-enhanced MR imaging of the spinal cord. MR abnormalities were multiple and enhancing, and located within the cervical and thoracic cord. Brain MR findings and brain biopsy specimens were positive for primary angiitis of the CNS. On follow-up MR studies, obtained after steroid and immunosuppressive therapy, a significant decrease in the number and size of the enhancing and nonenhancing abnormalities was observed, along with clinical improvement. Numerous small and enhancing abnormalities with a primarily posterior location, seen at the onset of the disease and resolved on follow-up studies, may be considered suggestive of a diagnosis of primary angiitis of the CNS.

Introduction of GDC embolization in the clinical practice as treatment synergical to surgery: impact on overall outcome of patients with subarachnoid hemorrhage

The GDC endovascular approach represent an effective alternative to surgery for treatment of intracranial aneurysms. Anyway no data are available about the impact of endovascular embolization with GDC on overall outcome of patients with subarachnoid hemorrhage. We analyse retrospectively a series of 234 patients admitted for ruptured intracranial aneurysm. Results were then compared with results of three surgical series from the literature. The 95.7% of patients underwent aneurysm treatment; 56.4% of patients were classified as good recovery, 12.8% presented moderate disability, 10.3% were severely disabled, 3% were in persistent vegetative state and 17.5% were dead. Patients older than 60 years accounted for 37% of all cases and good outcome in this group accounted for 54.7%. Good results were obtained in 90.1%, 61.7% and 22.8% of patients with Hunt-Hess grade I-II, III and IV-V respectively. Finally good outcome was observed in 82.8% of patients with aneurysms of the posterior circulation. Introduction of GDC embolization in clinical practice contributed to the extension of indication for aneurysm treatment leading to a reduction of overall mortality. GDC utilisation does not affect the overall percentage of patients with good outcome reflecting an increase of severely disabled patients. Endovascular treatment seems an effective theraputic choice in selected grade I-II patients. Results in grade III patients suggest that surgery may be advantageous because of washing and decompression of the basal cisterns while results in grade IV and V patients are unsatisfactory. GDC embolization clearly improves the prognosis of patients with posterior circulation aneurysms and probably is an advantageous theraputic choice in elderly patients.

Comparison of MRI pulse sequences for investigation of lesions of the cervical spinal cord

Small spinal cord lesions, even if clinically significant, can be due to the low sensitivity of some pulse sequences. We compared T2-weighted fast (FSE), and conventional (CSE) spin-echo and short-tau inversion-recovery (STIR)-FSE overlooked on MRI sequences to evaluate their sensitivity to and specificity for lesions of different types. We compared the three sequences in MRI of 57 patients with cervical spinal symptoms. The image sets were assessed by two of us individually for final diagnosis, lesion detectability and image quality. Both readers arrived at the same final diagnoses with all sequences, differentiating four groups of patients. Group 1 (30 patients, 53%), with a final diagnosis of multiple sclerosis (MS). Demyelinating lesions were better seen on STIR-FSE images, on which the number of lesions was significantly higher than on FSE, while the FSE and CSE images showed approximately equal numbers of lesions; additional lesions were found in 9 patients. The contrast-to-noise ratio (CNR) of 17 demyelinating lesions was significantly higher on STIR-FSE images than with the other sequences. Group 2, 19 patients (33%) with cervical pain, 15 of whom had disc protrusion or herniation: herniated discs were equally well delineated with all sequences, with better myelographic effect on FSE. In five patients with intrinsic spinal cord abnormalities, the conspicuity and demarcation of the lesions were similar with STIR-FSE and FSE. Group 3, 4 patients (7%) with acute myelopathy of unknown aetiology. In two patients, STIR-FSE gave better demarcation of lesions and in one a questionable additional lesions. Group 4, 4 patients (7%) with miscellaneous final diagnoses. STIR-FSE had high sensitivity to demyelinating lesions, can be considered quite specific and should be included in spinal MRI for assessment of suspected demyelinating disease.

Three-dimensional time-of-flight MR angiography in the evaluation of intracranial aneurysms treated with Guglielmi detachable coils

BACKGROUND AND PURPOSE

Intravascular treatment of intracranial aneurysms is a relatively new therapeutic technique and long-term controlled angiographic trials are needed to assess persistence of aneurysm occlusion. Our purpose was to evaluate the effectiveness of 3D time-of-flight (3D-TOF) MR angiography as a noninvasive screening tool in the follow-up of cerebral aneurysms treated with Guglielmi detachable coils (GDCs).

METHODS

Forty-nine patients with 50 intracranial aneurysms previously treated with GDCs were studied with both DSA and 3D-TOF MR angiography. In 14 cases, a second follow-up examination was performed, for a total of 64 aneurysms evaluated. In 25 aneurysms, both pre- and postcontrast MR angiographic studies were obtained.

RESULTS

In seven of 64 aneurysms, the MR angiographic studies were considered to be unreliable owing to the presence of artifacts that obscured part of the parent artery and did not allow an accurate evaluation of the aneurysm neck. These seven aneurysms, however, all were shown to be completely occluded at digital subtraction angiography (DSA). In the remaining 57 aneurysms, DSA revealed complete occlusion in 39 and the presence of residual patency in 18, whereas MR angiography showed complete occlusion in 38 and residual patency in 19. Enhanced MR angiography proved to be useful in evaluating residual patency in large and giant aneurysms and in better depicting the distal branch arteries.

CONCLUSION

Although artifacts related to the presence of coils are evident on a considerable number of imaging studies, our findings indicate that MR angiography is useful in the evaluation of residual patency of cerebral aneurysms treated with GDCs and may eventually prove valuable in the follow-up of those cases in which a good initial correlation with DSA was demonstrated.

Stent-graft treatment of a common carotid artery pseudoaneurysm

PURPOSE

To report a case demonstrating successful endovascular treatment of a right common carotid artery pseudoaneurysm using a commercially prepared balloon-expandable covered stent.

METHODS AND RESULTS

A 50-year-old man was evaluated for syncopal episodes. He had a history of severe trauma sustained in a motor vehicle accident 3 years before symptom onset. Doppler ultrasound scanning detected a pseudoaneurysm at the origin of the right common carotid artery. The defect measured 25 mm x 20 mm with a 22-mm-long neck on angiography and computed tomography; there was no evidence of carotid stenosis or associated vascular pathology. Via a percutaneous femoral access, 2 Jostent peripheral stent-grafts were placed at the level of the aneurysm, safely achieving complete repair of the arterial wall defect. The patient was asymptomatic at his 12-month evaluation. Color flow duplex scans showed continued exclusion of the pseudoaneurysm.

CONCLUSIONS

Wide-necked aneurysms in the extracranial carotid arteries may be treated with stent-grafts, which can achieve complete and permanent reconstruction of the arterial wall by excluding the aneurysm.

Method for intracellular magnetic labeling of human mononuclear cells using approved iron contrast agents

A method for intracellular iron labeling of human mononuclear cells (lymphocytes and monocytes) for magnetic resonance imaging (MRI) using simple incubation of cells with approved MRI iron contrast agents is presented. Labeled cells can be detected by MRI in vitro, and this suggests the possibility that the technique could become a marker for in vivo lymphocyte and monocyte trafficking studies in acute inflammatory lesions such as those in Multiple Sclerosis.

Emergency endovascular treatment of a life-threatening hemorrhage from traumatic rupture of the left extracranial vertebral artery

Hemorrhagic complications from transection of cervical arteries in blunt traumas are rare. We report a case of potentially fatal hemorrhage from rupture of the left vertebral artery in a closed trauma, successfully treated by endovascular injection of glue. Endovascular embolization may be considered as an alternative to surgical exploration in the treatment of traumatic lesions of vertebral arteries.

Post-traumatic dissecting aneurysm of extracranial internal carotid artery: endovascular treatment with stenting

Traumatic internal carotid dissection occurs frequently in motor vehicle accidents, typically extracranially, close to the skull base. Dissection may lead to stenosis or occlusion of the vessel, possibly with a pseudoaneurysm, symptoms ranging from neck pain to neurological deficits. In symptomatic patients and in cases of pseudoaneurysm, when conservative medical treatment fails, surgery or endovascular treatment are indicated. We report a post-traumatic dissecting aneurysm of the extracranial internal carotid artery successfully treated with stenting via a transfemoral approach.

Encephalocraniocutaneous lipomatosis: complete neuroradiologic evaluation and follow-up of two cases

Encephalocraniocutaneous lipomatosis (ECCL) is a rare neurocutaneous syndrome characterized by unilateral scalp, facial, and ocular lesions and ipsilateral cerebral malformations. To define the neuroimaging features of this disorder we studied two patients affected by ECCL and compared our data with those reported in the literature. Sonographic, CT, and MR imaging examinations showed quite specific CNS findings that are highly suggestive of the diagnosis of ECCL. To our knowledge this is the first report of a complete neuroradiologic evaluation and follow-up of this disorder.

Aneurysmal malformation of the vein of Galen in three patients: clinical and radiological follow-up

We studied three patients with aneurysmal malformations of the vein of Galen: all underwent embolisation followed by MRI and conventional angiography; two also underwent postembolisation magnetic resonance angiography (MRA). MRI was performed before treatment in two patients, MRA in only one, diagnosed prenatally. Two patients had normal appearances on follow-up MR studies and were completely cured by embolisation. However, the last patient, after two embolisations, despite the stabilisation of the clinical condition, underwent surgery and died. We think MRI is mandatory before endoarterial treatment, to assess the conditions of the brain. Angiography is mandatory only at the time of endovascular treatment, while MRA and MRI have a role in follow-up. Endoarterial embolisation remains the treatment of choice, and surgery is not advisable.

Intracranial vascular malformations

Many efforts and much research have been dedicated to the field of non-invasive angiographic techniques in the past few years. Thanks first to magnetic resonance angiography (MRA) and subsequently to computed tomographic angiography (CTA), very interesting results have been obtained in the diagnosis of cerebrovascular diseases. Neck vessels are most successfully evaluated by both MRA and CTA, and the need for digital subtraction angiography (DSA) examinations in patients at risk for vascular occlusions has significantly decreased. The role and the diagnostic accuracy of these non-invasive modalities in intracranial vascular pathology is still under investigation, and several studies have been and are being performed. Both techniques have a better spatial resolution and sensitivity in detecting cerebrovascular malformations than DSA. In the diagnosis of cerebral aneurysms, both MRA and CTA - due to their high sensitivity - have become screening techniques in the population at risk for subarachnoid hemorrhage, these techniques may become basic diagnostic modalities in treatment planning. The results are less satisfying in the evaluation of brain arteriovenous malformations and in the different steps of pre- and post-therapeutic evaluation.