Search

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

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

Aims To evaluate prospectively whether an intravenous gadolinium injection could improve the detection of the central vein sign on susceptibility-weighted imaging sequences obtained with a 1.5 T magnetic resonance scanner in patients with multiple sclerosis compared to unenhanced susceptibility-weighted images. Materials and methods This prospective, institution review board-approved study included 19 patients affected by multiple sclerosis (six men; 13 women; mean age 40.8 years, range 20–74 years). Patients had the relapsing–remitting clinical subtype in 95% of cases, and only one (5%) patient had the primary progressive clinical subtype of multiple sclerosis. T2-weighted images, fluid-attenuated inversion recovery images, unenhanced and contrast-enhanced susceptibility-weighted images were evaluated in consensus by two neuroradiologists for the presence of the central vein sign. The readers were blinded to magnetic resonance imaging reports, clinical information, the presence and the localisation of focal hyperintense white matter lesions. Any discordance between readers was resolved through a joint review of the recorded images with an additional neuroradiologist. Results A total of 317 multiple sclerosis lesions were analysed. The central vein sign had a higher prevalence detection rate on gadolinium-enhanced susceptibility-weighted images (272 of 317 lesions, 86%) compared to unenhanced susceptibility-weighted images (172 of 317 lesions, 54%). Conclusion Gadolinium-enhanced susceptibility-weighted imaging improves the detection rate of the central vein sign in multiple sclerosis lesions.

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

Purpose: High-grade glioma surgery has evolved around the principal belief that a safe maximal tumor resection improves symptoms, quality of life, and survival. Mapping brain function has been recently improved by resting-state functional magnetic resonance imaging (rest-fMRI), a novel imaging technique that explores networks connectivity at “rest.” Methods: This prospective study analyzed 10 patients with high-grade glioma in whom rest-fMRI connectivity was assessed both in single-subject and in group analysis before and after surgery. Seed-based functional connectivity analysis was performed with CONN toolbox. Network identification focused on 8 major functional connectivity networks. A voxel-wise region of interest (ROI) to ROI correlation map to assess functional connectivity throughout the whole brain was computed from a priori seeds ROI in specific resting-state networks before and after surgical resection in each patient. Results: Reliable topography of all 8 resting-state networks was successfully identified in each participant before surgical resection. Single-subject functional connectivity analysis showed functional disconnection for dorsal attention and salience networks, whereas the language network demonstrated functional connection either in the case of left temporal glioblastoma. Functional connectivity in group analysis showed wide variations of functional connectivity in the default mode, salience, and sensorimotor networks. However, salience and language networks, salience and default mode networks, and salience and sensorimotor networks showed a significant correlation (P uncorrected

Purpose Hepatic encephalopathy (HE) is a potential complication of cirrhosis. Magnetic resonance imaging (MRI) may demonstrate hyperintense T1 signal in the globi pallidi. The purpose of this study was to evaluate the performance of MRI-based radiomic features for diagnosing and grading chronic HE in adult patients affected by cirrhosis. Methods Adult patients with and without cirrhosis underwent brain MRI with identical imaging protocol on a 3T scanner. Patients without history of chronic liver disease were the control population. HE grading was based on underlying liver disease, severity of clinical manifestation, and number of encephalopathic episodes. Texture analysis was performed on axial T1-weighted images on bilateral lentiform nuclei at the level of the foramina of Monro. Diagnostic performance of texture analysis for the diagnosis and grading of HE was assessed by calculating the area under the receiver operating characteristics (AUROC) with 95% confidence interval (CI). Results The final study population consisted of 124 patients, 70 cirrhotic patients, and 54 non-cirrhotic controls. Thirty-eight patients had history of HE with 22 having an HE grade > 1. The radiomic features predicted the presence of HE with an AUROC of 0.82 (95% CI: 0.73, 0.90; P P P Conclusion In cirrhotic patients, MR radiomic is effective in predicting the presence of chronic HE and in grading its severity.

Purpose The aim of this study was to assess the novel advanced magnetic resonance imaging findings of acute stage cortical laminar necrosis developing after complicated cardiovascular or abdominal surgery. Materials and methods This institutional review board-approved study included patients with postoperative stroke due to cortical laminar necrosis imaged with magnetic resonance in the acute stage. Brain magnetic resonance imaging examinations were obtained on a 3T magnetic resonance scanner within 48 hours of the neurological symptoms, including diffusion-weighted images (b value, 1000 s/mm2) and arterial spin labelling using a pseudo-continuous arterial spin labelling method in four patients. Conventional and advanced magnetic resonance images were analysed to assess the imaging features in acute stage cortical laminar necrosis. Results The final population consisted of 14 patients (seven men and seven women, mean age 61 years, range 32–79 years) diagnosed with stroke and acute phase cortical laminar necrosis. All the patients presented with cortical lesions showing restricted diffusion on diffusion-weighted images and hypointensity on the apparent diffusion coefficient map. Cortical hyperintensity on T2-weighted or fluid-attenuated inversion recovery images was found in three (21%) and six (43%) patients, respectively. Reduced perfusion was noted in three out of four patients imaged with arterial spin labelling, while in one case no corresponding perfusion abnormality was noted on the arterial spin labelling maps. Arterial spin labelling abnormalities were much more extensive than diffusion restriction in two patients, and they were associated with a poor outcome. Conclusion Cortical hyperintense abnormalities on diffusion-weighted imaging may be the only sign of developing cortical laminar necrosis injury. The acquisition of arterial spin labelling helps to identify perfusion alterations and the extension of the ischaemic injury.

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

Age is the pivotal risk factor for different common medical conditions such as cardiovascular diseases, cancer and dementia. Among age-related disorders, cardiovascular and cerebrovascular diseases, represent the leading causes of premature mortality strictly related to vascular ageing, a pathological condition characterized by endothelial dysfunction, atherosclerosis, hypertension, heart disease and stroke. These features negatively impact on the brain, owing to altered cerebral blood flow, neurovascular coupling and impaired endothelial permeability leading to cerebrovascular diseases (CVDs) as Vascular Dementia (VD) and Parkinsonism (VP). It is an increasing opinion that neurodegenerative disorders and cerebrovascular diseases are associated from a pathogenetic point of view, and in this review, we discuss how cerebrovascular dysfunctions, due to epigenetic alterations, are linked with neuronal degeneration/dysfunction that lead to cognitive impairment. The relation between neurodegenerative and cerebrovascular diseases are reviewed with a focus on role of ncRNAs in age-related vascular diseases impairing the endothelium in the blood-brain barrier with consequent dysfunction of cerebral blood flow. In this review we dissert about different regulatory mechanisms of gene expression implemented by ncRNAs in the pathogenesis of age-related neurovascular impairment, aiming to highlight the potential use of ncRNAs as biomarkers for diagnostic/prognostic purposes as well as novel therapeutic targets.

We present the first case of acute and reversible Pisa Syndrome, as a clinical manifestation of a portosystemic encephalopathy bout occurring in a patient affected with cirrhosis and clinical-radiological signs of acquired hepatocerebral degeneration, without exposure to psychotropic medications. A 62 year-old man suffering from cirrhosis was admitted to our hospital for sudden onset of mild confusion and postural change. He was observed walking and standing with a tilt toward the right during the last two hours. On neurological examination, he showed bilateral asterixis and extrapyramidal signs. Clinical diagnosis of Pisa Syndrome was made in a setting of raised serum ammonia. A brain Magnetic Resonance Imaging showed bilateral altered signal intensities of globus pallidus and middle cerebellum peduncle, rarely reported in acquired hepatocerebral degeneration. The patient received medical treatment for portosystemic encephalopathy and the dystonic posture resolved. We suggest that transient ammonia increase and neuroimaging abnormalities, likely related to manganese deposits in the basal ganglia, might have caused an acute brain dysfunction, namely episodic portosystemic encephalopathy, characterized by clinical features of Parkinsonism as Pisa Syndrome.

Objective: The aim of this study was to retrospectively analyze the outcome of LR-3 and LR-4 without arterial phase hyperenhancement (APHE), and identify which features could predict LR-5 progression on serial Gd-EOB-DTPA-enhanced MRI follow-up. Methods: Forty-nine cirrhotic patients with 55 LR-3 and 19 LR-4 without APHE were evaluated. Observations were classified as decreased, stable or increased in category at follow-up. Observation size and LI-RADS major and ancillary features were evaluated. Results: Seventeen/fifty-five (31%) LR-3 and 8/19 (42%) LR-4 progressed to LR-5 at follow-up. Baseline LI-RADS major and ancillary features were not significantly different among LR-3 and LR-4. A diameter ≥ 10 mm significantly increased LR-5 progression risk of LR-3 (OR = 6.07; 95% CI: 0.12; 60.28]; P < .001). LR-4 with a diameter ≥ 10 mm more likely become LR-5 at follow-up (OR = 8.95; 95% CI: 0.73; 111.8; P = .083]). Conclusion: LR-3 and LR-4 without APHE were often downgraded or remained stable in category on Gd-EOB-DTPA-enhanced MRI follow-up.

To assess brain-core temperature of end-stage liver disease patients undergoing orthotopic liver transplantation (OLT) using a temperature measurement technique based on the apparent diffusion coefficient of the cerebrospinal fluid in the lateral ventricles. The study group was composed of 19 patients with a model for end-stage liver disease (MELD) score of 23.7 who underwent MR imaging before and after OLT. MR imaging studies were performed with a 1.5T MR scanner. Brain-core temperature (T: °C) was calculated using the following equation from the apparent diffusion coefficient (D) of the cerebrospinal fluid in the lateral ventricles: $$T = {{2256.74} \mathord{\left/ {\vphantom {{2256.74} {\ln \left( {4.39221/D} \right)}}} \right. \kern-0pt} {\ln \left( {4.39221/D} \right)}}{-}273.15$$ measured with a DWI sequence (b value 1000 s/mm2). We compared brain-core temperature of all patients before and after OLT. Brain-core temperature measurements were successfully taken in all patients before and after OLT. The measured brain-core temperature mean ± standard deviation was 38.67 ± 1.76 °C before OLT and 38.60 ± 0.99 °C after OLT, showing no significant difference (P = 0.643). Brain-core temperature was stable in patients undergoing OLT. DWI thermometry may provide a supplementary brain biomarker to confirm that cerebral blood flow and metabolism are stable in patients undergoing OLT.

Purpose: To assess the brain core temperature of Alzheimer disease (AD) patients in comparison with healthy volunteers using diffusion-weighted thermometry. Materials and methods: Fourteen AD patients (3 men, 11 women; age range 60–81 years, mean age 73.8 ± 6.1 years) and 14 healthy volunteers, age and sex-matched (mean age 70.1 ± 6.9 years; range 62–84 years; 5 men, 9 women) underwent MR examination between February 2014 and March 2016. MR imaging studies were performed with a 1.5-T MR scanner. Brain core temperature (T: °C) was calculated using the following equation from the diffusion coefficient (D) in the lateral ventricular (LV) cerebrospinal fluid: T = 2256.74/ln (4.39221/D) − 273.15 using a standard DWI single-shot echo-planar pulse sequence (b value 1000 s/mm2). Statistical analysis was performed using a nonparametric Wilcoxon rank-sum test to compare the patient and control groups regarding LV temperatures. Results: There was no significant difference (P = 0.1937) in LV temperature between patients (mean 37.9 ± 1.1 °C, range 35.8–39.2 °C) and control group (38.7 ± 1.4 °C, range 36.9–42.7 °C). Conclusions: Brain core temperature in AD patients showed no significant alterations compared to healthy volunteers.

Purpose The purpose of this article is to assess the diagnostic performance of computed tomography (CT) reformatted images for detection of superior semicircular canal (SSC) dehiscence. Material and methods Forty-two patients, with sound- and/or pressure-induced vestibular symptoms, and 42 control participants underwent helical CT examination with a highly collimated beam (0.5 mm). Reformatted images of the vestibular labyrinth were obtained in the standard axial and coronal planes (group A images), and in a plane parallel and perpendicular to the SSC (group B images). Diagnostic performance obtained by evaluating the group A images alone and the group B images alone was analyzed by using the area under the receiver operating characteristic curve (AUC). Results The diagnostic performance of group A images was AUC = 0.929 with an overall accuracy of 92.9%. The diagnostic performance of group B images was AUC = 0.988 with an overall accuracy of 98.8%. The evaluation of group B images alone showed an improved diagnostic performance over the group A images alone. Conclusion Thin-section 0.5-mm collimation CT with reformatted images oriented in the plane parallel and perpendicular to the SSC improves diagnostic accuracy in assessing for SSC dehiscence in comparison to CT images with reconstructions limited to traditional axial and coronal planes.

The aim of this study was to introduce resting-state functional magnetic resonance imaging (rest-fMRI) capability for brain tumor surgical planning. rest-fMRI is an emerging functional neuroimaging technique potentially able to provide new insights into brain physiology and to provide useful information regarding brain tumors in preoperative and postoperative settings. rest-fMRI evaluates low-frequency fluctuations in the blood oxygen level–dependent signal while the subject is at rest during magnetic resonance imaging examination. Multiple resting-state networks have been identified, including the somatosensory, language, and visual networks, which are of primary importance for surgical planning. We discuss the feasibility of rest-fMRI examination before and after surgical resection of brain tumors in routine clinical practice and the usefulness of the information obtained for surgical planning in brain tumor resection. rest-fMRI is particularly useful for patients who are unable to cooperate with the task-based paradigm, such as children or patients who are sedated, paretic, or aphasic. Although standardization and validation of rest-fMRI are still ongoing, this technique is feasible and valuable and can be implemented for routine clinical surgical planning. © 2019 Elsevier Inc.

Purpose The purpose of this study was to assess the accuracy of susceptibility-weighted imaging (SWI), compared with T2*-weighted gradient echo (GRE) imaging in assessing cerebral cavernous malformations. Materials and methods We retrospectively evaluated 21 patients with a familial form of cavernous malformation. Magnetic resonance (MR) protocol included non-enhanced and contrast-enhanced fast-spin echo (FSE) T1-weighted sequences, FSE T2-weighted sequences, fluid-attenuated inversion-recovery (FLAIR), GRE T2*-weighted and SWI sequences. Images were reviewed in consensus by two expert neuroradiologists to assess the location, number, size and conspicuity of the lesions on T2*-weighted GRE and SWI sequences. Statistical differences in the number, size and conspicuity of the lesions seen on the SWI images and the T2*-weighted GRE images were assessed with the nonparametric Wilcoxon signed rank test. Results The number of cavernous malformations was significantly higher ( p Conclusions The SWI sequence, being more sensitive to substances which distort the local magnetic field than the GRE T2*W sequence, showed a higher sensitivity in identifying cerebral cavernous malformations. Thus, routine clinical neuroimaging protocol should contain SWI sequences to evaluate patients with (or suspected) cerebral cavernous malformations.

Objectives The purpose of our study was to evaluate whether peritumoural perfusion weighted and proton spectroscopic magnetic resonance imaging can be used in differentiating between primary gliomas and solitary metastases. Methods Ten low-grade gliomas, eight high-grade gliomas and 10 metastases were prospectively evaluated with magnetic resonance imaging, dynamic susceptibility contrast enhanced perfusion imaging and single-voxel proton magnetic resonance spectroscopy before surgical resection or stereotactic biopsy. Maximal relative cerebral blood volume values were calculated drawing three regions of interest of 2 cm2 in the non-enhancing peritumoural areas. Maximal relative cerebral blood volume values were normalised to that of contralateral normal-appearing white matter. Maximal choline/creatine ratios were calculated from three voxels of 10 cm3 placed in the peritumoural areas defined as non-enhancing peritumoural white matter surrounding the tumour. The tumour grade presumed with these values was compared to histopathological grading. Differences in the study parameters between groups were assessed using the Mann–Whitney test. A receiver operating characteristic analysis was performed to determine cut-off values. Results A clear relative cerebral blood volume cut-off value of 1.88 was detected for differentiating low-grade gliomas from high-grade gliomas. A clear relative cerebral blood volume cut-off value of 1.20 was detected for differentiation of metastases from gliomas. The differences in the choline/creatine ratios in the peritumoural regions of high-grade gliomas and of solitary metastasis were statistically significant ( P Conclusion Our preliminary data support the hypothesis that peritumoural perfusion-weighted imaging can assist in preoperative differentiation between a glioma and a solitary metastasis.

Introduction The artery of Percheron is a rare anatomic variant supplying bilateral medial thalamic nuclei and a variable portion of the rostral part of midbrain. Case report A 48-year-old female with massive subarachnoid hemorrhage due to a ruptured aneurysm of the paramedian artery of Percheron presented to the emergency room. Because of significant risk of recurrent intracranial hemorrhage, it was decided to proceed with endovascular embolization of the aneurysm. The patient was ultimately sent to a rehabilitation center and her presenting neurologic deficits showed significant improvements in the weeks following endovascular embolization treatment. Discussion The paramedian artery of Percheron is a rare anatomic variant and subarachnoid hemorrhage due to aneurysm of this artery is exceedingly rare. This case underlines the importance of a correct evaluation of cerebral arterial anatomy in order to choose the best endovascular therapeutic approach, reduce complications, and optimize patient outcome.

Purpose: Cerebral microbleeds (CMBs) are small rounded lesions representing cerebral hemosiderin deposits surrounded by macrophages that results from previous microhemorrhages. The aim of this study was to review the distribution of cerebral microbleeds in patients with end-stage organ failure and their association with specific end-stage organ failure risk factors. Materials and methods: Between August 2015 and June 2017, we evaluated 15 patients, 9 males, and 6 females, (mean age 65.5 years). Patients population was subdivided into three groups according to the organ failure: (a) chronic kidney failure (n = 8), (b) restrictive cardiomyopathy undergoing heart transplantation (n = 1), and (c) end-stage liver failure undergoing liver transplantation (n = 6). The MR exams were performed on a 3T MR unit and the SWI sequence was used for the detection of CMBs. CMBs were subdivided in supratentorial lobar distributed, supratentorial non-lobar distributed, and infratentorial distributed. Results: A total of 91 microbleeds were observed in 15 patients. Fifty-nine CMBs lesions (64.8%) had supratentorial lobar distribution, 17 CMBs lesions (18.8%) had supratentorial non-lobar distribution and the remaining 15 CMBs lesions (16.4%) were infratentorial distributed. An overall predominance of supratentorial multiple lobar localizations was found in all types of end-stage organ failure. The presence of CMBs was significantly correlated with age, hypertension, and specific end-stage organ failure risk factors (p < 0.001). Conclusions: CMBs are mostly founded in supratentorial lobar localization in end-stage organ failure. The improved detection of CMBs with SWI sequences may contribute to a more accurate identification of patients with cerebral risk factors to prevent complications during or after the organ transplantation.

Purpose The aim of this study was to determine the occurrence and distribution of the ‘central vein’ sign in white matter lesions on susceptibility-weighted magnetic resonance images in patients with multiple sclerosis (MS) and cerebral small vessel disease (CSVD). Materials and methods T2-weighted and fluid-attenuated inversion recovery magnetic resonance images of 19 MS patients and 19 patients affected by CSVD were analysed for the presence and localisation of focal hyperintense white matter lesions. Lesions were subdivided into periventricular or non-periventricular (juxtacortical, subcortical, deep white matter and cerebellar) distributed. The number and localisation of lesions presenting with the central vein sign were recorded and compared between MS and CSVD lesions. Results A total of 313 MS patients and 75 CSVD lesions were identified on T2-weighted and fluid-attenuated inversion recovery magnetic resonance images. The central vein sign was found in 128 MS lesions (40.9%), and the majority of them (71/128, 55.5%) had a periventricular distribution. The central vein sign was found in 22 out of 75 (29.3%) CSVD lesions, and periventricular distribution was seen in six out of 22 (27.2%) CSVD lesions. The difference in the proportion of white matter hyperintense lesions that presented with the central vein sign on susceptibility-weighted images in patients with MS and CSVD was statistically different, and a significantly higher number of MS patients presented with lesions with the central vein sign compared to CSVD patients. Conclusion The presence of the central vein sign on susceptibility-weighted images for MS lesions improves the understanding of the periventricular distribution of MS lesions and could contribute as adjunctive diagnostic criteria for MS disease.

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

To retrospectively analyze the evolution of indeterminate hepatocellular nodules in cirrhotic patients on serial Gd-EOB-DPTA-enhanced MRI, and to identify predictors of HCC development. This IRB approved study included 33 cirrhotic patients with 69 indeterminate hepatocellular nodules (mean diameter 1.1 cm) at baseline Gd-EOB-DPTA-enhanced MRI and a Gd-EOB-DPTA-enhanced-MRI follow-up of at least 2 years. Two radiologists evaluated size and signal intensity of each nodule at baseline and follow-up. Age, cirrhosis etiology, and HCC history were recorded. Data were compared between nodules that became HCCs at follow-up (HCC) and those that did not (no-HCC). On follow-up, 5/69 nodules became HCCs and 64/69 showed indeterminate characteristics. HCC history was more frequently found in HCCs than in no-HCCs. Age, sex, and cirrhosis etiology were not significantly different between HCCs and no-HCCs. HCCs had a significantly greater baseline diameter and increase in size than no-HCCs. Hepatobiliary phase hypointensity was significantly more common in HCCs than in no-HCCs. Multivariate regression analysis showed that increase in size (OR 10.48; sensitivity, 100%; specificity, 81.2%; p

Purpose The objective of this study was to correlate the presence and distribution of cerebral microbleeds in Alzheimer’s disease patients with cerebrospinal fluid biomarkers (amyloid-beta and phosphorylated tau 181 protein levels) and cognitive decline by using susceptibility-weighted imaging magnetic resonance sequences at 1.5 T. Material and methods Fifty-four consecutive Alzheimer’s disease patients underwent brain magnetic resonance imaging at 1.5 T to assess the presence and distribution of cerebral microbleeds on susceptibility-weighted imaging images. The images were analyzed in consensus by two neuroradiologists, each with at least 10 years’ experience. Dementia severity was assessed with the Mini-Mental State Examination score. A multiple regression analysis was performed to assess the associations between the number and location of cerebral microbleed lesions with the age, sex, duration of the disease, cerebrospinal fluid amyloid-beta and phosphorylated tau 181 protein levels, and cognitive functions. Results A total of 296 microbleeds were observed in 54 patients; 38 patients (70.4%) had lobar distribution, 13 patients (24.1%) had non-lobar distribution, and the remaining three patients (5.6%) had mixed distribution, demonstrating that Alzheimer’s disease patients present mainly a lobar distribution of cerebral microbleeds. The age and the duration of the disease were correlated with the number of lobar cerebral microbleeds ( P Conclusion Lobar distribution of cerebral microbleeds is associated with Alzheimer’s disease and the number of lobar cerebral microbleeds directly correlates with cerebrospinal fluid amyloid-beta and phosphorylated tau 181 protein levels and with the cognitive decline of Alzheimer’s disease patients.

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

The aim of this study was to assess the value of computed tomography (CT) perfusion parameters in differentiating tissue viability in acute stoke patients.Thirteen patients (mean age 63.3 years) with nonhaemorrhagic stroke underwent multidetector perfusion CT within 3 h of symptom onset. Images were continuously acquired at the basal ganglia over 40 s during injection of 90 ml of iodinated contrast medium injected at a rate of 9 ml/s with a 9-s delay. Z-axis coverage was 20 mm. All patients underwent diffusion-weighted magnetic resonance imaging (DWI) within 12 h of perfusion CT to define the extent of the infarct. Perfusion CT data were analysed in regions of interests (ROIs) on regional cerebral blood volume (rCBV), regional cerebral blood flow (rCBF) and mean transit time (MTT) maps placed in various parts of the perfusion-deficient territory and in the contralateral hemisphere. Statistical analysis was performed using the analysis of variance (ANOVA) test to assess differences in CT perfusion parameters. Receiver operator characteristics (ROC) analysis was performed to assess possible threshold values that predict tissue infarction vs. viability.Normal CT findings with abnormal CT perfusion parameters were seen in the region of infarction and in the viable tissue (penumbra) within a 1.5-cm distance from the infarct margin as outlined on DWI images. Infarcted areas demonstrated significant prolongation of MTT values compared with noninfarcted areas (p0.0001). Average MTT was 9.8 s in areas of infarction, 5.1 s in the viable tissue adjacent to the infarct (penumbra), and 3.4 s in the contralateral control area. An MTT threshold level of 6.05 s has a 100% positive predictive value (sensitivity 84.6%, specificity 100%, accuracy 92.3%) for the presence of infarcted tissue. Average rCBF was 24.6 ml/100 g per min in infarcted tissue, 64.8 in penumbra and 70.8 in normal tissue. Average rCBV was 3.5 ml/100g in infarcted tissue, 3.9 in penumbra and 2.9 in normal tissue.Prolongation of MTT was the most frequent CT perfusion finding observed in acute stroke patients. Average MTT values of 5.1 s may distinguish viable tissue, whereas MTT values6.05 s identify infarcted tissue.

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

To assess the relationship between magnetic resonance (MR) imaging pituitary signal intensity reduction in patients with transfusional hemochromatosis and the clinical manifestation of hypogonadotropic hypogonadism.Pituitary MR imaging at 0.5 T was performed in 38 consecutive patients affected by secondary hemochromatosis and in 20 healthy volunteers. Serum ferritin levels were estimated in the affected population. Twenty (53%) of the 38 patients had hypogonadotropic hypogonadism diagnosed. Pituitary-to-fat signal intensity ratios were calculated from coronal gradient-echo (GRE) T2*-weighted MR images. The relationship between the quantitative reduction of the pituitary-to-fat signal intensity ratio and the clinical manifestation of pituitary dysfunction was assessed in the affected population. Signal intensity reduction in the anterior lobe of the pituitary gland was also correlated with the serum ferritin level.The degree of reduction of the pituitary-to-fat signal intensity ratio correlated with the presence of hypogonadotropic hypogonadism, with a sensitivity of 90%, a specificity of 89%, and an overall accuracy of 89%. In addition, the reduction of pituitary signal intensity was greater in patients with higher ferritin levels (r = -0.55, r(2) = -0.30, P.001).The degree of signal intensity reduction, measured as the pituitary-to-fat signal intensity ratio for GRE T2*-weighted images, in patients with secondary hemochromatosis correlates with the severity of pituitary dysfunction.

Background. We report an unusual paediatric presentation of acute Wernicke's encephalopathy in a 12-year-old boy affected by chronic gastrointestinal disease. MRI demonstrated, in addition to the typical diencephalic and mesencephalic signal abnormalities on T2-weighted images, enhancement of the mammillary bodies and the floor of the hypothalamus. Materials and methods. Following parenteral administration of thiamine for 4 days, the patient recovered from his neurological deficits and on follow-up enhanced MRI 1 month later, no signal abnormalities were found nor was there diencephalic or mesencephalic atrophy, as is usual in the chronic phase of the disease. Results. MRI provides crucial information in the diagnosis of Wernicke's encephalopathy, either in the acute or chronic phases of the disease. Conclusion. Our report provides an additional clue for recognition of the acute phase of the disease; enhancement of the floor of the hypothalamus has not previously been described despite its recorded involvement at autopsy.

To identify pituitary iron overload in patients with transfusional hemochromatosis causing secondary hypogonadism, we prospectively evaluated signal intensity abnormalities of the anterior lobe of the pituitary gland of 18 patients affected by transfusion-dependent thalassemia major and secondary hypogonadism. Magnetic resonance (MR) imaging is useful to assess pituitary iron overload in patients with transfusional hemochromatosis and secondary hypogonadism by detection of a significant decreased signal intensity of the anterior lobe of the pituitary gland on GRE T2*-weighted images. The decreased signal intensity of the anterior lobe of the pituitary gland on GRE T2*-weighted images was correlated to increasing serum ferritin level (r=−0.84,r 2=−0.70,P

Scuba diving is associated with risk of severe decompression sickness (DCS type II), which results from rapid reduction of the environmental pressure sufficient to cause the formation into tissue or blood of inert gas bubbles previously loaded within tissues as a soluble phase. DCS type II constitutes a unique subset of ischemic insults to the central nervous system (CNS) with primarily involvement of the spinal cord. Ten patients with diving-related barotrauma underwent neurologic examination. Two of them presented progressive sensory and motor loss in the extremities at admission and were presumed affected by spinal cord DCS. Magnetic resonance imaging (MRI) demonstrated abnormalities in the white-matter tracts of the spinal cord in these patients, in each case corresponding to an area of the cord believed to be clinically involved. After a course of therapeutic recompressions, one patient was able to stand and walk a short distance, and MRI revealed a decreased extension of areas of spinal cord abnormalities. MRI has proved to be reliable in the detection of pathologic changes of spinal cord decompression sickness that were previously undetectable by other neuroimaging methods and also has proved to be useful in the follow-up during therapeutic hyperbaric recompressions.

The objective of this study was to assess the long-term natural history of focal confluent fibrosis in cirrhotic liver with CT.Two radiologists retrospectively reviewed in consensus 118 liver CT examinations in 26 patients (19 men, seven women; age range, 32-68 years; mean age, 50 years) performed over approximately 6 years. Helical CT scans were obtained before and 30-35 and 65-70 seconds after injection of 125-150 mL of contrast medium at a rate of 4-5 mL/s. Proof of cirrhosis was based on liver transplantation (n = 6), biopsy (n = 9), or imaging findings (n = 11). The number, location, and attenuation of fibrotic lesions and presence of trapped vessels were evaluated. Variation of hepatic retraction associated with the development of focal confluent fibrosis lesions was assessed using the ellipsoid volume formula and an arbitrary retraction index.Each radiologist identified 41 focal confluent fibrosis lesions. All lesions were identified by both radiologists. Twelve patients (46%) had a single lesion, 13 (50%) had two lesions, and one (4%) had three lesions. Thirty-four (83%) of 41 lesions were located in segment IV, VII, or VIII. Thirty-two lesions (78%) were hypoattenuating on unenhanced images, 25 lesions (61%) were hypoattenuating on hepatic arterial phase images, and 20 lesions (49%) were isoattenuating on portal venous phase images. Seven lesions (17%) were or became hyperattenuating at follow-up on portal venous phase images. Trapped vessels were found in six lesions (15%). The retraction index showed a significant increase over time (r = 0.423, por = 0.0001).The degree of capsule retraction associated with focal confluent fibrosis evolves with time and relates to the natural evolution of cirrhosis.

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

The purpose of this study was to describe the findings and evaluate the role of multidetector (40–slice) computed tomography (MDCT) in the preoperative assessment of gastrointestinal stromal tumours (GISTs). Thirteen patients with histologically proven GIST (size: 4–30 cm; mean: 9 cm) underwent 40–slice MDCT after the ingestion of 1,000 ml of water. Images were obtained before and 70 s after intravenous injection of 120 ml of iodinated contrast agent. Two experienced radiologists reviewed the CT findings to evaluate lesion site, size, margins, attenuation, growth pattern, enhancement pattern, ascites, lymphadenopathy, direct invasion to adjacent organs and distant metastasis. Multiplanar maximum intensity projection and three–dimensional (3D) reconstructions were also obtained. Seven out of 13 GISTs were located in the jejunumileum, 3/13 in the stomach, 2/13 in the rectum and in one case, the origin remained unknown. Eleven out of 13 were exophytic, and ten had well–defined borders. Two out of 13 showed calcifications. Thirteen out of 13 exhibited inhomogeneous enhancement due to areas of necrosis and cystic degeneration. Direct invasion to adjacent organs (n=3), ascites (n=3), and liver (n=1) and peritoneal (n=1) metastases were also detected. Bowel obstruction, vascular invasion and lymphadenopathy were never seen. MDCT allowed reliable preoperative assessment of GIST, providing useful clues for lesion characterisation.

This paper describes our experience in developing a DICOM (Digital Imaging and Communications in Medicine) server based on widely available personal computers enabling to use X-ray digital images for teaching and scientific purposes.The system is based on a DICOM server running on a widely used personal computer. The selected DICOM images are collected directly from the radiological equipment or from a dedicated 3D image processing workstation through a LAN connection and converted into one of the standard formats (JPEG or GIF) to allow their direct importing into multimedia presentations for teaching or scientific purposes.This system allows fast and easy collection of radiological images in DICOM format directly from the diagnostic equipment or from the graphical workstation. These images may be used for scientific and teaching presentations without loss of image quality and colour characteristics in 3D images as there is no off-line acquisition process.The extensive possibilities of implement the system described on widely used PCs makes the system extremely versatile and facilitates the preparation of teaching material and scientific publications.

The aim of the present study is to report our experience using digital cineradiography to assess morphological and functional disorders of the pharynx in patients with prior partial or total laryngectomy.From March 2000 to October 2002, 21 patients (18 males and 3 females) with prior total laryngectomy (12 patients), total laryngopharyngectomy (2 patients) and partial laryngectomy (7 patients) were examined. A digital cineradiography with 12 frames/second acquisition was performed in all patients. In four patients the procedure was interrupted for massive barium aspiration, without cough (silent aspiration). In 17 patients standing in the left posterior oblique position and prone in the right posterior oblique position the oesophagus and oesophagogastric junction were also examined. The water siphon test was performed at the end of the procedure. Small boluses (10 ml) of liquid (60% w/v) and high-density (250% w/v) barium, barium paste (110% w/v), and solid meal (obtained spreading a dry biscuit with barium paste) were used.All patients with prior total laryngectomy and total laryngopharyngectomy showed morphological and functional disorders of the neopharynx: parapharyngeal diverticulum (2 cases), submandibular pouch (6 cases), fistulas (2 cases), lumen narrowing and post-surgical stenoses (2 cases), tumour recurrence (1 case), prominent cricopharynx (5 cases) and rhinopharyngeal reflux (4 cases). All patients with prior partial laryngectomy (7 cases) presented silent aspiration. Eleven patients had an oesophageal motility disorder, which was very serious in three of them with decrease in oesophageal clearing and barium retention in the oesophagus. Oesophagogastric junction evaluation showed hiatus hernia in six cases, two of them with associated gastro-oesophageal reflux.Digital cineradiography appears able to identify the organic and functional postoperative complications of patient treated with partial or total laryngectomy. A special swallowing study can suggest to the speech therapist the best compensatory mechanism for improving patient swallowing and therefore quality of life.

To assess the prognostic value of hyperattenuating middle cerebral artery sign at CT in acute cerebral infarction.Ninety-two patients with acute cerebral infarction in the sylvian area were retrospectively reviewed. All patients underwent unenhanced CT 12-24 hours after the onset of symptoms and follow-up CT within 48-72 hours. Initial CT scans were evaluated by consensus by three radiologists to confirm or exclude the presence of hyperattenuating middle cerebral artery sign. History, cardiovascular risk factors and neurological impairment at discharge (mean 25 days) were recorded for each patient. The degree of disability was graded 0 (no disability) to 6 (death). Patients were divided into two groups: patients without (group A) and patients with (group B) hyperattenuating middle cerebral artery sign. A logistic regression analysis was performed to compare the two groups. Results were correlated with cardiovascular risk factors. Kaplan-Meier survival curves were calculated for each group.Hyperattenuating middle cerebral artery sign was present in 18 patients (19.6%) (group B). The percentage of neurological deficits was significantly higher in group B than in group A (p0.05). Sixteen (88.9%) of the 18 patients in group B had a poor prognostic index (score 3 - 6) with a significantly higher percent difference (41.6%, p0.05) than patients of group A. Within 10 days of admission, 3 patients (16.7%) died in group A and 6 (8.1%) in group B. However, no significant differences were observed in the Kaplan-Meier survival curves. No correlation with cardiovascular risk factors was observed.Besides having an important diagnostic value, hyperattenuating middle cerebral artery sign is a reliable predictor of prognosis in terms of disability rather than mortality, as it reflect the larger extension of infarction.

We report the neuroimaging findings in a group of systemic disorders with a common pathophysiological pattern of derangements in cerebral vascular autoregulatory mechanism producting potentially reversible brain lesions.We reviewed the brain CT and MR examinations of 14 patients with clinical diagnosis of vasculopathy not related to atherosclerosis or cardiogenic embolism. The patients were admitted at the onset of neurologic deficit and were affected with one of the following systemic disorders: thrombotic thrombocytopenic purpura (TTP, 6 cases), uremic encephalopathy (4 cases), eclampsia (2 cases), 1 chronic renal failure from systemic lupus erythematosus and 1 cyclosporin neurotoxicity. All patients underwent neuroimaging follow-up within 7-20 days of the onset of neurologic deficit and the start of anti-edema therapy.CT and MR findings were characterized by cortical-subcortical or deep brain lesions related to edema. Ten patients presented bilateral lesions, which were symmetric in 4 cases. Edema resolution was demonstrated on follow-up examinations after therapy in 4 patients (2 with eclampsia, 1 with TTP and 1 with uremic encephalopathy). The lesions showed no signs of regression in 10 patients.Brain lesions with a common pathogenesis from derangements in vascular autoregulatory mechanism--i.e., not due to atherosclerosis or cardiogenic embolism--should be properly and promptly recognized because they can be reversible and readily treatable.

The main cause of death in beta-thalassemia major patients is congestive heart failure which is traditionally referred to myocardial iron overload. Recently, some investigators have found that cardiac failure is not caused by the iron overload. In their opinion, left-sided heart failure develops years after the onset of acute myocarditis and might be related to a late autoimmune process. Right-sided heart failure is related to the combination of left ventricular diastolic restriction and pulmonary hypertension. The aim of this work is to study myocardial iron overload by MRI and to correlate the signal intensity changes of the myocardium with cardiac function.Sixteen patients with beta-thalassemia major were examined with a .5 super-conducting unit. SE and cine-GE sequences were used in the 4 chamber and 2 chamber views. Left ventirclar ejection fraction (EF) was calculated by using the biplane area-length method. Right ventricular size was assessed by measuring the end-diastolic anteroposterior diameter (APD). Myocardial signal intensity was evaluated qualitatively and quantitatively (myocardium/subcutaneous fat) in all the beta-thalassemia patients and in 10 normal volunteers.Left ventricular function was decreased (EF55%) in 2/16 patients. The right ventricle was dilated in 5/16 patients (APD42 mm). The myocardium had a lower signal intensity than that of normal volunteers in 15/16 patients. No statistical correlation was found between myocardial signal intensity and serum ferritine levels or cardiac function.The small number of patients in our series does not allow any definitive statements. However, our results show that cardiac function is not influenced by myocardial iron overload.

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

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

An inexpensive, easy-access computer-based system is proposed, which was developed for the systematization of the clinical series of knee joint disorders studied with Magnetic Resonance Imaging (MRI). The system is based upon the integration of multimedia technology and Data Base Management Systems (DBMS). The hardware configuration for this project included an Apple Macintosh workstation based on a Motorola 68040 microprocessor and a customized application developed by the authors with the 4th Dimension software. The MR images available only on film were digitized off-line with a solid-state Charge Coupled Device (CCD) scanner with back-light cover for transparency. Otherwise, MR images were acquired on-line through an Ethernet-based local area network from the MR unit or from a SparcStation-Advantage Windows workstation connected with the MR unit. Image post-processing was performed with the Adobe PhotoShop software. The system was devoted to the systematization and analysis of a clinical series of 800 MR studies of the knee. A mean of 10 significant MR images were stored for each examination with a standard image compression algorithm--the Joint Photographic Experts Group (JPEG). This permitted us to save the system's storage space and at the same time to preserve image quality for consultation and teaching purposes, not for diagnosis which is made on the backboard or on the MR unit's or Advantage Window's monitor. Finally, MR findings were indexed with a customized check-list specific for knee joint disorders. On the basis of stored and selected information, it was thus possible to carry out a statistical analysis and to make detailed reports which are useful for scientific purposes, such as the preparation of lectures and papers. Moreover, the system was very useful for patients' follow-up and for the preparation of hypermedia teaching applications on knee joint disorders which are available on the Internet at our World-Wide Web server (URL: http://mbox.unipa.it/radpa/radpa ++ +.html). In conclusion, the system is a cost-effective and user-friendly solution for the multipurpose management of radiologic series.

Magnetic Resonance Imaging (MRI) is a valuable technique to study knee meniscal tears. A series of 330 patients with knee traumas was retrospectively reviewed to systematize the semiologic features of a particular kind of meniscal tear, the "bucket-handle" one. MR investigations were performed with an 0.5-T superconductive magnet, surface coil and spin-echo T1-weighted and gradient-echo (FFE) T2*-weighted sequences on the coronal and the sagittal planes. Twenty-nine patients exhibited bucket-handle tears, 25 of the medial and 4 of the lateral meniscus. In all 29 patients joint effusion was observed; in 18 patients capsulo-ligamentous lesions were associated. MR findings were confirmed by arthroscopy and/or surgery. Semiologic features characterizing the bucket-handle tear on the coronal plane are: truncated triangular shape of the peripheral meniscus and low-intensity band between the posterior cruciate ligament and the tibial plateau, corresponding to the central fragment displaced in the intercondylar notch. In the lateral meniscus, the fragment is found beneath the anterior cruciate ligament. On the sagittal plane this band parallels the posterior or anterior cruciate ligaments, depending on the involved meniscus, with a typical "second cruciate posterior or anterior ligament" or "third cruciate ligament" pattern. The semiology of such findings of bucket-handle meniscal tears is useful in the differential diagnosis with other kinds of meniscal tears.

It is widely known that US results strictly depends on operators and that each operator follows individual pathways. Therefore the authors have tried to develop high-interactivity tools, allowing the "customization" of learning to the user's demands. Progress linked to microprocessors' technology allowed a wide spread of cost-effective electronic processors with high graphic performances, capable of supporting sophisticated softwares which are useful to develop multimedial programs. Our experiment is aimed at integrating a multimedial management system for US studies, with the training activity of the medical staff US-expert. The system is structured on a hardware platform based on the Motorola microprocessor, class 68040, an application software developed by Apple. The environment for multimedial applications development uses the "Hypercard" interface of graphic presentation, by Apple. The software allows the realization of a multimedial environment of learning, where US images are associated with graphics, drawing and text references. The application allows a multimedial environment of learning for normal eidodiagnostic anatomy of the female reproductive system, where different courses can be followed autonomously. On the basis of a check performed on a group of students, although in a preliminary stage, the combination of conventional didactic material with either a paper or television support, with devices allowing the connection of texts, graphics and images in a dynamic way, proved to be very useful and to allow personal courses of learning, which can be always modified in an interactive way.

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

To investigate the correlations between traumatic injuries of the anterior cruciate ligament and other ligamentous, meniscal and bone traumatic injuries, a series of 193 patients with anterior cruciate ligament injuries studied with MRI between January 1992 and December 1994, was retrospectively reviewed. MR results were compared with arthroscopic and/or surgical findings in most (181) patients; in the remaining 12 patients, clinical follow-up was performed. We used two 0.5 superconductive MR units, with dedicated coils and T1-weighted spin-echo and T2*-weighted gradient-echo sequences on the axial, sagittal and coronal planes. Anterior cruciate ligament injuries were associated with other ligamentous, meniscal and bone injuries in 78% of patients. The patients were classified in 5 groups depending on biomechanics and the association of injuries: -group I: isolated injury of the anterior cruciate ligament (41 patients), most frequently caused by forced extension stress associated with "kissing contusions" of the anterior portion of the lateral femoral condyle and of the lateral tibial plateau; this type of injury is less frequently caused by forced flexion stress associated with avulsion fracture of the tibial eminence; -group II: associated injury of the anterior cruciate ligament and medial compartment (62 patients), caused by forced flexion-external rotation stress (abduction, valgism and external rotation). The classic association of this mechanism was the injury of the anterior cruciate ligament, medial collateral ligament and medial meniscus (O'Donoghue triad) (9 patients). Valgus stress and the pivot-shift phenomenon can impact the tibial and femoral articular surfaces, with consequent osteochondral contusion; -group III: associated injury of the anterior cruciate ligament and lateral compartment (26 patients), caused by forced flexion-internal rotation stress (adduction, varism and internal rotation). This mechanism can cause, as a typical bone lesion, Segond fractures; -group IV: associated injury of the anterior cruciate ligament, lateral and medial compartments observed in 52 patients with different associations of varus-valgus and rotatory stress; -group V: in 5 patients, anterior cruciate ligament injury was associated with traumatic injury of the posterior cruciate ligament; in this case, posterior displacement of the tibia and knee hyperextension were the most common mechanisms of injury. In conclusion, our results demonstrate that anterior cruciate ligament injuries due to traumatic sprains of the knee are rarely isolated (21%). Thus, it is important to know the biomechanics of knee trauma to read MR images in order to detect possibly associated injuries. The final goal is to assess the actual extent of the traumatic damage for best subsequent clinical-therapeutic management.

We investigated the role of Magnetic Resonance Imaging (MRI) in the diagnosis of neurotoxoplasmosis and in the evaluation of drug treatment response.Twenty-six AIDS patients (22 men and 4 women, mean age 26.7 years) with clinical suspicion of neurotoxoplasmosis were examined. A patient was considered to have neurotoxoplasmosis if there were signs of focal neurologic impairment and a positive/questionable response to the serum test for Toxoplasma gondii. MR images were acquired with T1-weighted spin-echo (SE) and inversion recovery (IR) sequences and with T2-weighted SE sequences. Gd-DTPA was administered in all cases. After the beginning of therapy with sulfadiazine and pyrimethamine all patients were submitted to clinical and neuroradiologic follow-up for 60 days.MR examinations on admission demonstrated at least one brain lesion in all patients and multifocal involvement in 70% of cases. Enhancing lesions were found in 90% of patients (83% ring enhancement, 4% focal enhancement, 3% mixed patterns). The most frequent lesion sites were the basal ganglia and thalami (70%). The brain lesions were subdivided into 4 groups by their morphology and signal patterns.The time course of clinical and neuroradiologic responses demonstrates a rapid improvement after the first week of therapy, which stabilized after the second week. Pearson correlation between clinical and neuroradiologic treatment responses showed a nearly linear correlation (r = .97; p.001). The diagnosis was then confirmed in all patients based on the positive response to the serum test for Toxoplasma gondii (IgG12 UI/mL) and/or clinical and neuroradiologic improvement after therapy.This study demonstrates the accuracy of MRI in the detection of toxoplasmosis brain lesions and in the evaluation of treatment response.

The aim of this study was to evaluate MR imaging changes of the pancreas in patients with transfusion-dependent beta-thalassemia major.Twenty patients with transfusion-dependent beta-thalassemia major were examined using MR imaging at 0.5 T, with spin-echo T1-weighted, fast spin-echo T2-weighted, and gradient-echo T2*-weighted sequences. Image analysis was performed to assess pancreas-to-fat signal intensity ratios for all pulse sequences. Pancreatic exocrine and endocrine function and serum ferritin levels were assessed. Twenty healthy volunteers underwent MR imaging with the same three sequences and served as a control group.The pancreas-to-fat signal intensity ratio was significantly decreased in 17 (85%) of the 20 patients on spin-echo T1-weighted images (p.05), fast spin-echo T2-weighted images (p.01), and gradient-echo T2*-weighted images (p.01) when compared with the 20 volunteers in the control group. The pancreas-to-fat signal intensity ratio was significantly increased in three (15%) of the 20 patients on spin-echo T1-weighted images (p.01) and fast spin-echo T2-weighted images (p.05). In addition, in the 20 patients, we found a significant correlation between increased pancreas-to-fat signal intensity ratios and decreased serum trypsin levels (r = -.77, p.01 for spin-echo T1-weighted sequences; r = -.75, p.05 for fast spin-echo T2-weighted sequences; and r = -.74, p.05 for gradient-echo T2*-weighted sequences). Likewise, for the 20 patients, we found a significant correlation between decreased pancreas-to-fat signal intensity ratios and increased serum ferritin levels for gradient-echo T2*-weighted images (r = -.65, p.01). No correlation was found for the other clinical parameters evaluated.MR imaging revealed signal intensity changes in the pancreas of patients with transfusion-dependent beta-thalassemia major. Patients with a major impairment of the exocrine pancreatic function had higher signal intensity of the pancreas because of fatty replacement of the parenchyma.