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Cranial nerve palsy in internal carotid artery (ICA) dissection occurs in 3--12% of all patients, but in 3% of these a syndrome of hemicranias and ipsilateral cranial nerve palsy is the sole manifestation of ICA dissection, and in 0.5% of cases there is only cranial nerve palsy without headache. We present two cases of lower cranial nerve palsy. The first patient, a 49-year-old woman, developed left eleventh and twelfth cranial nerve palsies and ipsilateral neck pain. The angio-RM showed an ICA dissection with stenosis of 50%, beginning about 2 cm before the carotid channel. The patient was treated with oral anticoagulant therapy and gradually improved, until complete clinical recovery. The second patient, a 38-year-old woman, presented right hemiparesis and neck pain. The left ICA dissection, beginning 2 cm distal to the bulb, was shown by ultrasound scanning of the carotid and confirmed by MR angiogram and angiography with lumen stenosis of 90%. Following hospitalisation, 20 days from the onset of symptoms, paresis of the left trapezius and sternocleidomastoideus muscles became evident. The patient was treated with oral anticoagulant therapy and only a slight right arm paresis was present at 10 months follow-up. Cranial nerve palsy is not rare in ICA dissection, and the lower cranial nerve palsies in various combinations constitute the main syndrome, but in most cases these are present with the motor or sensory deficit due to cerebral ischemia, along with headache or Horner's syndrome. In the diagnosis of the first case, there was further difficulty because the cranial nerve palsy was isolated without hemiparesis, and the second case presented a rare association of hemiparesis and palsy of the eleventh cranial nerve alone. Compression or stretching of the nerve by the expanded artery may explain the palsies, but an alternative cause is also possible, namely the interruption of the nutrient vessels supplying the nerve, which in our patients is more likely.

Abnormalities of the hypothalamo-hypophyseal axis are frequently associated with pituitary deficiency. We describe a previously unknown morphological presentation of the ectopic posterior neurohypophyseal “bright spot.”

Plexiform neurofibromas usually occur in the neck, pelvis, and extremities. Jaws and oral cavity plexiform neurofibromas have also been described. Magnetic resonance (MR) patterns for neurofibromas are typical. They include low-to-intermediate signal intensity on T1-weighted images, enhancement of the solid component of the tumor after contrast medium administration, heterogeneity on T2-weighted images, and in some cases, multiple target signs due to a collagen central area. We report MR findings of two neurofibromatosis type 1 (NF1) patients with enlarging tongue plexiform neurofibromas.

To evaluate a patient population affected by Neurofibromatosis type 1 (NF1) with special reference to optic pathway gliomas.A total of 419 NF1 patients (222 men, 197 women) were retrospectively evaluated to show incidence, biological behaviour, neuroradiological and clinical presentation of optic pathway gliomas. Central Nervous System MR and ophthalmologic evaluations were reviewed.Thirty-two patients out of 419 (7.6%) showed the presence of optic pathway gliomas. Of these, 28 (87.2%) patients showed tumoral involvement of the optic chiasma. The right intracranial optic nerve was involved in 15 patients (46.8%), the left intracranial optic nerve in 18 (56.2%), the right extracranial optic nerve in 11 (34.3%), the left extracranial optic nerve in 10 (31.2%) and the right and left optic tracts in 6 (18.7%) patients. Geniculate body and optic radiation were not involved by tumour diffusion. Visual acuity testing was positive in 26/32 (81.2%), the fundus oculi in 11/32 (34.3%) patients and the visual field evaluation in 12/32 (37.5%) patients.In this study we showed an high correlation between optic pathway tumours and ophthalmologic abnormalities confirming the usefulness of an integrated clinical-neuroradiological approach in patients affected by NF1. We also described the biological behaviour of these tumours in our NF1 patient population.

To investigate the relationship between Magnetic Resonance (MR) findings and the presence of isolated growth hormone deficiency (IGHD) or multiple pituitary hormone deficiency (MPHD).39 children, 27 boys and 12 girls (mean age 9.6 years) were enrolled. The growth hormone deficiency and MPHD were defined by standard laboratory methods. MR scans of the hypothalamo-hypophyseal tract were carried out on all patients before the therapy. Perinatal histories were reviewed.The pituitary anterior lobe was considered small in 13/39 (33%). Twenty-six of 39 (66%) patients did not show any abnormalities of the hypothalamohypophyseal tract. An ectopic neurohypophysis was found in 8/39 patients (20%). Only 2 patients among those with an ectopic neurohypophysis showed a small anterior pituitary lobe. Thirty-three of 39 (84.6%) patients showed IGHD while 6/39 (15.4%) patients showed MPHD. Twenty-eight of 39 (71%) patients had a severe deficiency while 11/39 (28%) patients had a moderate deficiency.Our study confirms the usefulness of MRI in the diagnostic and therapeutic approach to short stature in children; in fact 48% of patients in our series showed MR findings reasonably related to hormonal deficiency.

Liver metastases from colorectal, gastric and breast cancers are a very frequent event; these metastases are treated with cycles of intraarterial chemotherapy with a permanent catheter positioned in the hepatic artery or with surgical or interventional radiology techniques. We tested Arai's technique and its feasibility and evaluated the efficacy of this chemotherapy schedule.Four patients with liver metastases from colorectal carcinoma were treated with combined systemic and locoregional chemotherapy with a permanent catheter placed in the hepatic artery according to Arai's technique. Arai's technique consists in studying the hepatic vascularization and then redistributing hepatic flow in case of multiple hepatic arteries; the vessels in which the infusion of chemotherapies could cause toxicity are then occluded and finally a catheter is positioned in the hepatic artery with subclavian artery catheterization and the connection with a subcutaneous reservoir for injection--the port-a-cath system. We planned CT examinations to study liver morphology and radiographs of the abdomen and chest to depict the catheter position and patency, respectively.The catheter was positioned correctly without any complications in all patients, as planned. We administered 37 cycles of combined systemic and locoregional chemotherapy in all. Two patients died of disease progression after 6 months but the other 2 are still alive and CT showed partial disease remission. We observed no catheter dislocation or occlusion at chest radiography and transport angiography, respectively.Infusion chemotherapy in the hepatic artery from permanent catheters is widely accepted in our country and we believe that Arai's technique could be an alternative to the more classic and established surgery. The small number of our patients and the short follow-up do not permit definitive conclusions to be drawn on the clinical efficacy of this combined systemic and intra-arterial treatment.

A "quality team" in radiology, whose members are the authors of this paper, has implemented a quality control program to test the cassettes with intensifying screen systems used in radiology departments. 149 systems-124 of them for general purpose radiology and 25 for mammography-were submitted to the following tests: visual inspection of radiographic cassettes and intensifying screens, screen-film contact, intensifying screen cleanliness and relative sensitivity of the intensifying screens. The results of each type of test are reported in detail in the paper, on a 3-point scale: good, sufficient and poor. The overall results of the quality control tests show 78% of general purpose radiology cassettes to qualify as good (69%) or sufficient (9%), while 22% were of poor quality. 88% of the mammographic cassettes qualified as good (76%) or sufficient (12%), while 12% were of poor quality. All tests were easy to perform and required limited resources. The necessary procedures to keep quality high over time are also reported. To conclude, the results obtained with our quality control program could be used as an effective tool to address and plan the turnover of the cassettes with intensifying screens which are usually used in diagnostic radiology practice.

Eleven patients who had undergone cardiac surgery were studied by means of high-field MR imaging (1.5 T). Six patients had had aortic root and valve replaced with a Björk-Shiley (BS) composite tubular aortic graft prosthesis for acute dissection of ascending aorta. In the other 5 patients with rheumatic calcific aortic disease, the valve had been replaced with a BS prosthesis. As a whole, MRI studies were 14. Previous evaluations of magnetic field effects had seem carried out ex vivo on both BS valves and BS composite prostheses, on surgical ligation clips (Tantalium and Stainless) and on stainless wires for sternal closure. In 4 patients (2 BS composite grafts and 2 BS valves) MRI diagnosed chronic dissection of both arch and descending aorta. In 1 of them, with a BS valve, associated localized acute dissection of ascending aorta was observed. In 3 patients with BS composite grafts, MRI revealed pseudo-aneurysms (including a thrombosed one) at the graft level. In one case MRI was repeated 4 times and was very helpful in monitoring the pseudo-aneurysm. MRI showed pericardial hematoma in 2 patients with BS grafts and paravalvular abscess in a case with BS valve. In one patient with BS valve fast-imaging MR revealed severe aortic regurgitation. No adverse reactions were demonstrated on MR images of prosthetic implants. MRI artifacts were insignificant with the spin-echo technique, while the fast-imaging technique showed clear image distortion at the valve level.