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Purpose: To investigate the impact of iterative metal artifact reduction (iMAR) on artifacts related to neurosurgical clips or endovascular coils when combined to filtered back projection (FBP) or advanced modelled iterative reconstruction (ADMIRE). Material and Methods: In this study 21 unenhanced brain computed tomography (CT) examinations were reconstructed with FBP and level 2 of ADMIRE, both techniques with and without iMAR algorithm, resulting in 4 series per acquisition. Subjective assessment of artifact reduction was performed as a double-blinded evaluation with a 5-point-scale. Objective analysis was performed by comparing central tendencies and distributions of voxel densities. The central tendency was assessed as the mean voxel density in Hounsfield units. The distribution was assessed by evaluating the shape and asymmetry of the histograms of voxels densities with measures of kurtosis and skewness, respectively. Results: Inter-reader agreement was excellent (>0.8). FBP and ADMIRE without iMAR were scored 4 and with iMAR 5. Unusual artifacts were noted in all of the series reconstructed with iMAR, especially when combined with ADMIRE. Kurtosis revealed statistical differences for all reconstruction techniques (p ≤ 0.0007) except for the association of FBP with iMAR (p = 0.2211) for the coiling population and skewness demonstrated no statistical difference in any population (p ≥ 0.0558), confirming the subjective analysis results, except for the ADMIRE algorithm with or without iMAR (p ≤ 0.0342) in the coiling population. Conclusion: iMAR led to the reduction in artifacts due to intracranial metallic devices. However, it created a new artifact in the form of a halo of photon-starvation, especially when combined with ADMIRE. The combination of FBP and iMAR seems more suitable, combining the beneficial metal artifact reduction without the emergence of a halo of photon starvation just around the point of interest. [ABSTRACT FROM AUTHOR]

Objectives: Bing-Neel syndrome (BNS) is a rare neurological complication of Waldenström's macroglobulinemia. The aim of this study is to describe the spectrum of radiological manifestations of this syndrome and their prevalence in order to facilitate its early diagnosis.Methods: Twenty-four patients with BNS were diagnosed between 1994 and 2016 in eight centres in France. We retrospectively examined the medical records of these patients as well as the corresponding literature, focusing on imaging studies. Recorded data were statistically analysed and radiological findings described.Results: The mean age of our patients was 62.4 years (35-80 years). The vast majority of patients were men, with a male to female ratio of 9:1. Findings included parenchymal or meningeal involvement or both. The most common finding was leptomeningeal infiltration, either intracranial or spinal, with a prevalence reaching 70.8%. Dural involvement was present in 37.5% of patients. In 41.7% (10/24) of patients, there was parenchymal involvement with a higher prevalence of brain comparing to medullar involvement (33.3% and 23.1% respectively). High T2 signal of the parenchyma was identified in 41.7% of patients and high signal in diffusion was evident in 25% of them. Intraorbital or periorbital involvement was also detected in four cases. A proposition regarding the appropriate imaging protocol completed our study.Conclusion: BNS's diagnosis remains challenging. Central nervous system MRI findings in the setting of known or suspected Waldenström's macroglobulinemia appear to be highly suggestive of BNS and appropriate imaging protocols should be implemented for their depiction.Key Points: • Diagnosis of Bing-Neel syndrome (BNS) remains challenging and recent expert recommendations include MRI in the diagnostic criteria for the syndrome. • The most common radiological manifestations of BNS are leptomeningeal/dural infiltration or parenchymal involvement of brain or spinal cord, but many atypical forms may exist with various presentations. • Appropriate imaging protocol for BNS should include enhanced MRI studies of both brain and spine. [ABSTRACT FROM AUTHOR]

Eye movements are a complex task requiring a large number of structures coordinated by three cranial nerves and their centres in the brainstem. Various pathologies may affect any part of the pathway controlling the eye movements and their diagnosis is often based on history and clinical examination. Modern advances in computed tomography and magnetic resonance imaging have recently added a valuable tool in the diagnosis of oculo-motor-related diseases., Competing Interests: Erklärung zu finanziellen Interessen Forschungsförderung erhalten: nein; Honorar/geldwerten Vorteil für Referententätigkeit erhalten: nein; Bezahlter Berater/interner Schulungsreferent/Gehaltsempfänger: nein; Patent/Geschäftsanteile/Aktien (Autor/Partner, Ehepartner, Kinder) an im Bereich der Medizin aktiven Firma: nein; Patent/Geschäftsanteile/Aktien (Autor/Partner, Ehepartner, Kinder) an zu Sponsoren dieser Fortbildung bzw. durch die Fortbildung in ihren Geschäftsinteressen berührten Firma: nein. Erklärung zu nichtfinanziellen Interessen Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Computer tomography (CT) and magnet resonance imaging (MRI) are valuable imaging tools in order to examine various pathologies of the visual pathways. The advantage of CT is its short acquisition time of a few minutes, its availability making it an ideal tool in emergency medicine. It is extremely valuable in patients with cranio-cerebral trauma when an orbital or skull fracture or an intracerebral haemorrhage has to be assessed. In addition, CT-Angiography is used in the management of patients with an acute stroke. CT is mandatory to visualize the orbit in many conditions. The most important disadvantage is its use of ionizing radiation. Thus, CT is contraindicated in pregnant woman. Contrast of soft tissue as brain tissue is inferior compared to MRI. The latter has a high sensitivity in visualizing all kind of brain pathologies including tumours, inflammatory conditions or brain oedema as a result of a stroke. In contrast to CT, MRI (without contrast agent) can be used in pregnant women. The disadvantages of MRI are its long acquisition time, its contraindication in patients with metallic implants including pacemaker and its low resolution of bony tissue. Both imaging tools are often used in a complementary way in many orbital diseases, pathologies affecting bony structures, pathologies with calcifications and in stroke patients., Competing Interests: Erklärung zu finanziellen Interessen Forschungsförderung erhalten: nein; Honorar/geldwerten Vorteil für Referententätigkeit erhalten: nein; Bezahlter Berater/interner Schulungsreferent/Gehaltsempfänger: nein; Patent/Geschäftsanteile/Aktien (Autor/Partner, Ehepartner, Kinder) an im Bereich der Medizin aktiven Firma: nein; Patent/Geschäftsanteile/Aktien (Autor/Partner, Ehepartner, Kinder) an zu Sponsoren dieser Fortbildung bzw. durch die Fortbildung in ihren Geschäftsinteressen berührten Firma: nein. Erklärung zu nichtfinanziellen Interessen Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

The etiology of epilepsy is variable and sometimes multifactorial. Clinical course and response to treatment largely depend on the precise etiology of the seizures. Along with the electroencephalogram (EEG), neuroimaging techniques, in particular, magnetic resonance imaging (MRI), are the most important tools for determining the possible etiology of epilepsy. Over the last few years, there have been many developments in data acquisition and analysis for both morphological and functional neuroimaging of people suffering from this condition. These innovations have increased the detection of underlying structural pathologies, which have till recently been classified as "cryptogenic" epilepsy. Cryptogenic epilepsy is often refractory to anti-epileptic drug treatment. In drug-resistant patients with structural or consistent functional lesions related to the epilepsy syndrome, surgery is the only treatment that can offer a seizure-free outcome. The pre-operative detection of the underlying structural condition increases the odds of successful surgical treatment of pharmacoresistant epilepsy. This article provides a comprehensive overview of neuroimaging techniques in epilepsy, highlighting recent advances and innovations and summarizes frequent etiologies of epilepsy in order to improve the diagnosis and management of patients suffering from seizures, especially young patients and children.

Bing Neel syndrome is a rare disease manifestation of Waldenström's macroglobulinemia that results from infiltration of the central nervous system by malignant lymphoplasmacytic cells. In this guideline we describe the clinical symptoms, as well as the appropriate laboratory and radiological studies, that can aid in the diagnosis. The presentation of Bing Neel syndrome may be very diverse, and includes headaches, cognitive deficits, paresis, and psychiatric symptoms. The syndrome can present in patients with known Waldenström's macroglobulinemia, even in the absence of systemic progression, but also in previously undiagnosed patients. Diagnostic work-up should include cerebral spinal fluid analysis with multiparameter flow cytometry to establish B-cell clonality, protein electrophoresis and immunofixation for the detection and classification of a monoclonal protein as well as molecular diagnostic testing for immunoglobulin gene rearrangement and mutated MYD88. MRI of the brain and spinal cord is also essential. The second challenge is to expand our knowledge of prognosis and treatment outcome. Prospective clinical trials on Bing Neel syndrome patients that employ uniform treatment along with appropriate laboratory cerebral spinal fluid assessments and standardized MRI protocols will be invaluable, constituting a significant step forward in delineating treatment outcome for this intriguing disease manifestation., (Copyright© Ferrata Storti Foundation.)

Central nervous system involvement by malignant cells is a rare complication of Waldenström macroglobulinemia, and this clinicopathological entity is referred to as the Bing-Neel syndrome. There is currently no consensus on the diagnostic criteria, therapeutic approaches and response evaluation for this syndrome. In this series, we retrospectively analyzed 44 French patients with Bing-Neel syndrome. Bing-Neel syndrome was the first manifestation of Waldenström macroglobulinemia in 36% of patients. When Waldenström macroglobulinemia was diagnosed prior to Bing-Neel syndrome, the median time interval between this diagnosis and the onset of Bing-Neel syndrome was 8.9 years. This study highlights the possibility of the occurrence of Bing-Neel syndrome without any other evidence of progression of Waldenström macroglobulinemia. The clinical presentation was heterogeneous without any specific signs or symptoms. Biologically, the median lymphocyte count in the cerebrospinal fluid was 31/mm(3). Magnetic resonance imaging revealed abnormalities in 78% of the cases. The overall response rate after first-line treatment was 70%, and the overall survival rate after the diagnosis of Bing-Neel syndrome was 71% at 5 years. Altogether, these results suggest that Bing-Neel syndrome should be considered in the context of any unexplained neurological symptoms associated with Waldenström macroglobulinemia. The diagnostic approach should be based on cerebrospinal fluid analysis and magnetic resonance imaging of the brain and spinal axis. It still remains difficult to establish treatment recommendations or prognostic factors in the absence of large-scale, prospective, observational studies., (Copyright© Ferrata Storti Foundation.)

During development in utero of the human brain, an error in one or more of the orderly processes of neuroblast proliferation and differentiation, neuroblast migration and cortical organization may result in disordered neocortical development. Nowadays, the consequent malformations of the cerebral cortex and associated structures are detectable on pre- and postnatal examination with growing frequency, thanks to the evolution of modern imaging modalities. In particular, magnetic resonance imaging (MRI), due to its excellent contrast differentiation and multiplanar capabilities as well as the development of even newer techniques, such as diffusion tensor imaging and spectroscopy, has surpassed all other forms of imaging for the thorough exploration and analysis of congenital anomalies of the central nervous system. These malformations comprise a heterogeneous group of conditions in terms of both the timing and etiology of the developmental aberration as well as the resulting morphological phenotype, including epilepsy, developmental delay/intellectual disability and focal neurological deficits. This study briefly presents some typical examples of congenital malformations of cortical development of the human brain that are encountered in practice. It is our belief that familiarity with the MRI presentations of these conditions can be of considerable value for adequate disease management and genetic counseling., (Copyright © 2011 Elsevier Masson SAS. All rights reserved.)