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Cardiovascular magnetic resonance (CMR) is a useful noninvasive technique for determining the presence of microvascular obstruction (MVO) and intramyocardial hemorrhage (IMH), frequently occurring in patients after reperfused myocardial infarction (MI). MVO, or the so-called no-reflow phenomenon, is associated with adverse ventricular remodeling and a poor prognosis during follow-up. Similarly, IMH is considered a severe damage after revascularization by percutaneous primary coronary intervention (PPCI) or fibrinolysis, which represents a worse prognosis. However, the pathophysiology of IMH is not fully understood and imaging modalities might help to better understand that phenomenon. While, during the past decade, several studies examined the distribution patterns of late gadolinium enhancement with different CMR sequences, the standardized CMR protocol for assessment of IMH is not yet well established. The aim of this review is to evaluate the available literature on this issue, with particular regard to CMR sequences. New techniques, such as positron emission tomography/magnetic resonance imaging (PET/MRI), could be useful tools to explore molecular mechanisms of the myocardial infarction healing process.

Alterations of the brain microstructure and metabolism have been identified in patients with neurofibromatosis type 1 (NF1). In this study, we analyzed the basal ganglia of NF1 subjects without cognitive delay throughout a combined approach with magnetic resonance spectroscopy (MRS) and diffusion tensor imaging (DTI) in order to better define the metabolic and microstructural characteristics of these regions and, furthermore, to verify if metabolic and microstructural abnormalities may be present in normally developed NF1 patients. A 3-T MRI with multivoxel MRS and DTI was performed in 14 NF1 patients and eight controls. N-acetyl-aspartate (NAA), choline (Cho), creatine (Cr) values and ratios, fractional anisotropy, and apparent diffusion coefficient (ADC) were calculated, for a total of four regions of interest (ROI) for each hemisphere. NF1 patients, compared to healthy controls, showed (a) decreased NAA in all the four ROI, (b) increased Cho and decreased Cr in three of the four ROI, (c) decreased NAA/Cho ratio in three ROI, and (d) increased ADC in all the four ROI. A trend of increased ADC was present in three of the four ROI of NF1 patients with unidentified bright objects (UBOs) and younger than 18 years. These data confirm the presence of neuroaxonal damage with myelin disturbances in NF1 patients. We showed that metabolic and microstructural anomalies can be present in the same time in NF1 patients without developmental delay or cognitive deficits. Relations between brain anomalies, UBOs, and cognitive functions need further studies.

Acute pancreatitis is one of the more commonly encountered etiologies in the emergency setting. While in the majority of cases it is a self-limiting disease which responds rapidly to conservative management, in some cases acute pancreatitis may present with a more pronounced, sometimes dramatic, clinical picture and requires immediate medical care to avoid fatal complication. In this context, imaging plays a significant role because it enables identification of the development of the disease and local/systemic complications. The purpose of this article is to offer an overview of the disease and a spectrum of imaging findings in patients with acute pancreatitis, emphasizing the role of ultrasound, computed tomography, and magnetic resonance imaging according to the appropriate clinical context and advantages and limitations of each imaging modality are examined.

Granulomatous prostatitis is a benign inflammatory condition of the prostate which can be mistaken for prostatic carcinoma both clinically and on imaging findings. In MR imaging, granulomatous prostatitis has been shown to cause signal intensity decrease in the prostatic peripheral zone similar to carcinoma on T2-weighted sequences. The recent introduction of 3D MR spectroscopy (3D MRS) into clinical practice adds information to the morphological data of endorectal MRI, enabling a more accurate localization and diagnosis of prostate cancer and chronic prostatitis. We describe two cases which had been diagnosed, respectively, 15 and 18 months earlier with transitional cell carcinoma of the bladder. They had subsequently been treated with a regimen of intravescical bacilli Calmette-Guerine (BCG). These two patients underwent combined endorectal MRI and 3D MRS imaging of the prostate in which findings were suggestive of prostatic carcinomas instead histological exam showed to be granulomatous prostatites.

In more than 20% of all patients, the Crohn’s disease presents before the age of 18years. The diagnosis and management of Crohn’s disease in children has changed dramatically over the last decade, mainly due to increased awareness, availability of newer diagnostic modalities such as magnetic resonance imaging (MRI) and newer, more powerful treatments such as biologics. Imaging of the small bowel is needed for diagnosis, management, follow-up and also evaluation of the disease in terms of location, extent, activity and complications. We review all the methods (barium examinations, ultrasonography, computed tomography, MR, and computed tomography- positron emission tomography) commonly used for imaging the small bowel in paediatric patients with Crohn’s disease analyzing the advantages and disadvantages of each modality, with particular emphasis on MR imaging.

Atherosclerotic plaques can be responsible for life-threatening cardiovascular and cerebrovascular events. Some features of the plaque, such as a thin fibrous cap, large necrotic core, macrophage infiltration, neovascularization, and intraplaque hemorrhage, are associated with a major risk of such events and so their assessment is fundamental. Novel imaging techniques, each one with its own strength and drawbacks, can help in the evaluation and quantification of atherosclerosis. An analysis of the recent literature was carried out. The different techniques were compared by evaluating the accuracy of each one in the detection and assessment of the atherosclerotic plaque's features named above.

PURPOSE: To investigate the behavior of circulating endothelin (ET)-1 concentrations in patients affected by systemic sclerosis, and to elucidate the possible relationships existing in this disease among plasma peptide levels, pulmonary hypertension, and lung fibrosis. PATIENTS AND METHODS: Circulating ET-1 levels were determined by reverse-phase, high-pressure liquid chromatography followed by sensitive radioimmunoassay in 20 patients affected by systemic sclerosis (18 women and 2 men, mean age 48.1 +/- 13.7 years) with or without pulmonary hypertension as evaluated by Doppler echocardiography, or lung fibrosis as measured by a score method based on lung examination by high-resolution computed tomography (HRCT). A group of 18 normal volunteers served as controls (15 women and 3 men, mean age 45.0 +/- 10.1 years). RESULTS: Plasma ET-1 levels were significantly higher (P < 0.001) in patients with systemic sclerosis (1.72 +/- 0.28 pg/mL) than in control subjects (0.63 +/- 0.06 pg/mL). Pulmonary artery systolic hypertension was detected in 10 patients (50%) with systemic sclerosis (56.2 +/- 18.0 mm Hg, range 37 to 97) versus none of the control subjects (30.2 +/- 2.2 mm Hg, P < 0.0001). Lung fibrosis was present in 12 patients (60%), with an HRCT overall score of 9.0 +/- 4.6. There were no significant differences in plasma ET-1 levels between patients with pulmonary hypertension (1.58 +/- 0.20 pg/mL) or without it (1.76 +/- 0.39 pg/mL, P = 0.188, not significant [NS]); or between patients with lung fibrosis (1.65 +/- 0.14 pg/mL) or without fibrosis (1.78 +/- 0.37 pg/mL, P = 0.290, NS). In particular, 6 patients had neither pulmonary hypertension nor lung fibrosis. In these patients, plasma ET-1 levels were similar compared with the others (1.85 +/- 0.49 versus 1.66 +/- 0.13, respectively; P = 0.180, NS). No correlations were observed between ET-1 levels and either pulmonary pressure levels or HRCT overall scores. CONCLUSIONS: The use of a sensitive assay, highly selective for ET-1, showed higher levels of circulating peptide in patients affected by systemic sclerosis than in control subjects. Neither pulmonary hypertension nor lung fibrosis was accompanied by a further rise in plasma ET-1 concentrations.

Last years technological developments in imaging field have made a substantial contribution to diagnosis and staging of rectal cancer. Endorectal ultrasound and MRI with endorectal coil are very useful in rectal cancer initial staging thanks to their ability to distinguish between the rectal wall layers. Major ultrasound limitations are presence of inflammations, desmoplastic reaction and small field of view which limits evaluation of perirectal invasion. MRI with phased-array coils, instead, allows depiction of mesorectum and to assess the distance between tumor and mesorectal fascia. Unfortunately CT shows low accuracy compared to MRI in local staging because it fails to distinguish the rectal wall layers. The criterion used in assessing nodal involvement remains unfortunately still the dimensional one even if new contrast media based on nano-iron particles look promising in this regard On reassessment after chemo-radiotherapy treatment, MRI proved to be a very accurate tool thanks to its ability to detect tumor downstaging, disappearance of mesorectal fascia infiltration or even to show a complete response. The presence of recurrence can be studied by contrast enhanced perfusion-MRI or with good accuracy using PET which, however, presents major technical limitations at present.

Background: Unenhanced computed tomography (CT) is the imaging technique used in acute stroke. In some cases it is unable to detect damage even 24–48 h after symptom onset. The aim of our work was to evaluate the diagnostic value of diffusion-weighted imaging (DWI) in the post-acute phase of cerebral ischemia in patients in whom CT did not yield a definitive diagnosis. Methods: We retrospectively evaluated DWI findings in 214 patients, out of a series of 1,680 patients admitted to our hospital following the acute onset of focal neurological symptoms, in whom non-contrast CT, performed within 30 h of symptom onset, was normal (123), incongruous, i.e. a marked hypodensity indicative of an old infarct or a slight hypodensity not consistent with the clinical findings (66), or leukoaraiotic, i.e. diffuse chronic hypodensities in the periventricular white matter (25). Results: DWI showed signs of recent brain ischemia in 125/214 (58%) patients: 64/123 (52%) with a normal CT, 41/66 (62%) with an incongruous CT, and 20/25 (80%) with leukoaraiosis (p = 0.027). Multiple lesions were detected in 16/125 (16%) patients, while single lesions were ≤2 cm in 83/109 (76%) cases. DWI showed signs of ischemia in 22/91 (24%) patients with TIA and in 103/123 (84%) patients with stroke (p = 0.0001). Conclusion: In a quite high proportion of patients with recent symptoms of transient ischemic attack/ischemic stroke and a repeat non-diagnostic CT, DWI may help in the diagnosis of ischemic stroke and in shedding light on the underlying pathogenic mechanism.

The objective of our study was to evaluate the sensitivity and specificity of endorectal MRI combined with dynamic contrast-enhanced MRI to detect local recurrence after radical prostatectomy.A total of 51 patients who had undergone radical prostatectomy for prostatic adenocarcinoma 10 months to 6 years before underwent a combined endorectal coil MRI and dynamic gadolinium-enhanced MRI before endorectal sonographically guided biopsy of the prostatic fossa. The MRI combined with MR dynamic imaging results were correlated with the presence of recurrence defined as a positive biopsy result or reduction in prostate-specific antigen level after radiation therapy.Overall data of 46 (25 recurred, 21 nonrecurred) out of 51 evaluated patients were analyzed. All recurrences showed signal enhancement after gadolinium administration and, in particular, 22 of 24 patients (91%) showed rapid and early signal enhancement. The overall sensitivity and specificity of MR dynamic imaging was higher compared with MRI alone (88%, [95% CI] 69-98% and 100%, 84-100% compared with 48%, 28-69% and 52%, 30-74%). MRI combined with dynamic imaging allowed better identification of recurrences compared with MRI alone (McNemar test: chi-square(1) = 16.67; p =0.0001).MRI combined with dynamic contrast-enhanced MRI showed a higher sensitivity and specificity compared with MRI alone in detecting local recurrences after radical prostatectomy.

To establish the additional value of 3D magnetic resonance spectroscopy (3D-MRS) imaging to endorectal MR imaging in the diagnosis of prostrate cancer in the peripheral zone. MR imaging and MRS imaging were performed in 79 patients with suspicion of prostate cancer on the basis of digital rectal exploration, transrectal ultrasound and PSA level. All the examinations were performed with 1.5 T MR scan using an endorectal coil (transverse and coronal FSE T2-weighted sequences, axial SE T1-weighted and PRESS 3D CSI). MR examinations have been evaluated by two Radiologists blind of the clinical data in a “per patients” analysis. MR imaging and MRS imaging findings were compared with the result of histological data from radical prostatectomy in 53 patients and biopsy in 17 patients. Nine patients (11.4%) were excluded because of serious artefacts in the MR spectrum. The reported values of sensitivity, specificity, PPV and NPV for MR imaging alone were respectively 84%, 50%, 76% and 63% (LR+ 1.7; LR− 0.3). Instead the reported values of sensitivity, specificity, PPV and NPV for the combination of MR imaging to MRS imaging were respectively 89%, 79%, 89% and 79% (LR+ 4.28; LR− 0.14). We found an incremental benefit of MRS imaging to MR imaging for tumour diagnosis although these results did not show statistically significant differences. The MRS imaging improves the accuracy of the endorectal MR imaging in the diagnosis of prostate cancer.

The results of recent studies of magnetic resonance imaging (MRI) combined with three-dimensional magnetic resonance spectroscopic imaging (3D-MRSI) demonstrate that the MRI/3D-MRSI exam is a unique method by which to noninvasively study the cellular metabolism and anatomy of the prostate. 3D-MRSI is emerging as the most specificity tool for non-invasive evaluation of the prostate cancer. The results of current MRI/3D-MRSI studies also provide evidence that the magnitude of metabolic changes in regions of cancer before therapy, as well as the extent of the time course of metabolic changes after therapy, may improve our understanding of cancer aggressiveness. Assessment of cancer spread outside the prostate can be significantly improved by combining MRI findings with estimates of metabolic abnormalities provided by 3D-MRSI. Clinically, combined MRI/3D-MRSI has already demonstrated a potential for improved diagnosis, staging, and treatment planning for patients with prostate cancer. This article reviewed the value of 3D-MRS imaging for the diagnosis, localization, staging, aggressiveness, and treatment planning of prostate cancer.

We describe a single case of a polymalformational syndrome in which the MR findings were of great help in the final diagnosis of Smith-Lemli-Opitz syndrome (SLOS) type I. MRI was performed for evaluation of the brain morphology since the clinical and laboratory findings were suggestive but not unequivocally indicative of SLOS. MRI findings of frontal lobe hypoplasia, cortical migration defect, and abnormalities of median line structures prompted the final diagnosis of SLOS.

PURPOSE: The aim of the present study was to compare the accuracy of endorectal coil magnetic resonance imaging with transrectal ultrasound in staging rectal carcinoma. METHODS: Twenty-six consecutive patients with rectal carcinoma, histologically proven by endoscopic biopsy, were staged with both endorectal coil magnetic resonance imaging and transrectal ultrasound and then underwent radical surgery. The preoperative staging was compared with histologic findings of the operative specimen according to TNM classification. RESULTS: Endorectal coil magnetic resonance imaging showed better results but was not statistically significantly different from transrectal ultrasound in evaluating T (accuracy, 84.6vs. 76.9 percent): four overstaged and no understaged cases for the former and five overstaged cases and one understaged case for the latter. Both procedures showed similar results in evaluating N: 81 percent sensitivity and 66 percent specificity for endorectal coil magnetic resonance imaging and 72 percent sensitivity and 80 percent specificity for transrectal ultrasound. CONCLUSIONS: An accurate locoregional staging of rectal cancer is essential for the planning of optimal therapy for rectal cancer. Endorectal coil magnetic resonance imaging and transrectal ultrasound showed similar results; the former is more expensive, whereas the latter is operator dependent. At present the use of endorectal coil magnetic resonance imaging seems to be justified only in selected low rectal cancers where transrectal ultrasound yielded doubtful results. However, a more extensive study is necessary to compare the advantages of these diagnostic techniques.

Background & Aims: The most effective prophylaxis for colorectal cancer is endoscopic polypectomy. Prompted by the disadvantages of conventional colonoscopy (CC), we assessed the diagnostic ability of a promising alternative technique for detecting endoluminal masses: magnetic resonance colonography (MRC). Methods: Seventy consecutive patients referred for CC underwent preliminary MRC. The diagnostic ability of this technique in detecting colonic endoluminal lesions was determined, compared with that of CC, and related to the findings from histologic examination. Results: In detecting endoluminal lesions, MRC achieved a diagnostic accuracy similar to CC (sensitivity, 96%; specificity, 93%; positive predictive value, 98%; and negative predictive value, 87.5%). Conclusions: MRC could be useful in screening programs of patients at high risk for colon cancer. Patients with MRC-detected endoluminal lesions must undergo CC for histologic diagnosis. GASTROENTEROLOGY 2000;119:300-304

Several studies have repeatedly demonstrated that leukoaraiosis as well as ventricular enlargement are common findings in normal elderly and in stroke patients, although there is no general consensus on prevalence rate as well as on their clinical correlations. It is also controversial whether white matter changes and ventricular enlargement are reciprocally related. In this study we investigated the prevalence and extent of white matter hyperintensities and the degree of ventricular enlargement on magnetic resonance imaging in 50 normal elderly individuals (mean age 62.1 ± 7.3 years) and in 50 consecutive chronic ischemic stroke patients (mean age 66.1 ± 7.7 years). All subjects underwent extensive clinical assessment. White matter hyperintensities were graded from 0 to 3 on a semi-quantitative scale, while bifrontal horn, bicaudate, and third ventricle ratio indices were used as measures of brain atrophy. Hypertension, diabetes, alcohol consumption, cardiac disease, carotid pathology occurred significantly more often in patients than in controls. Prevalence rates of white matter hyperintensities were 30% in controls and 82% in patients. Patients had significantly larger ventricular indices than controls. Significant univariate correlations for the extent of white matter hyperintensities were found with age, sex, hypertension, cardiac disease, carotid pathology, diabetes, history of stroke and ventricular enlargement. Age, sex, cardiac disease, alcohol habit, cerebrovascular disease and extent of white matter hyperintensities correlated with severity of ventricular enlargement. Multivariate regression analysis identified age, hypertension and history of stroke as independent predictors of white matter hyperintensities, while history of stroke, age and alcohol consumption were found as the only independent predictors of ventricular enlargement Separate analysis between periventricular, subcortical or deep white matter hyperintensities and each of the three ventricular indices failed to show a significant association after adjustment for clinical and demographic factors. We suggest that leukoaraiosis and ventricular enlargement are independent pathological processes associated with different risk factors in addition to age and stroke disease.

This study investigates the relationship between depression and both anatomic and cerebral blood flow abnormalities in multiple sclerosis (MS) patients. Ten nondepressed MS patients were compared with 10 depressed MS patients matched for age, sex, and functional disability. Both groups were evaluated by means of neuropsychological tests, magnetic resonance imaging, and single-photon emission tomography imaging. There was no difference between the two groups with regard to the global cognitive score. Magnetic resonance imaging data showed no significant differences in the number, side, location, and area of the demyelinating lesions between the two groups; however, regional cerebral blood flow asymmetries in the limbic cortex did distinguish the two groups. Analysis of variance showed a significant effect of depression on the perfusion asymmetries in the limbic cortex. Finally, perfusion asymmetries in limbic cortex significantly correlated with depression test scores. Our findings suggest that depression in MS patients could be induced by a disconnection between subcortical and cortical areas involved in the function of the limbic system.

T2-weighted magnetic resonance imaging has been shown to be effective in detecting changes in cerebral white matter. High signal intensity in cerebral white matter regions has been suggested to be indicative of the presence of a disease state. In normal aging, white matter changes, known as leuko-araiosis, have been reported to be widespread. Some studies have linked leuko-araiosis to aging and risk factors for stroke. There is also evidence that changes in cerebral white matter occur in hydrocephalus and that enlargement of the lateral ventricles is a byproduct of severe white matter changes. This study reports data on the frequency and severity of leuko-araiosis in normal subjects and patients with cerebrovascular disease and explores the relationship between white matter changes and ventricular dilatation.

A 38 years old woman and her first cousin, a 41 year old man, presented both with hypertension, hypokalemia, hyperaldosteronism, and low plasma renin activity in our Hospital. In both patients, plasma and urine aldosterone were constantly above the normal range, even on a high NaCl diet (250 mEq/day), while the plasma aldosterone response to postural changes was normal. In the female patient abdominal ultrasonic scan, CT scan, MRI, and adrenal gland phlebography were normal, but blood from the left adrenal vein contained 1002 pg/ml of aldosterone, versus 91 pg/ml in the contralateral one. Interestingly, the secretion of cortisol was also lateralized (plasma cortisol levels being of 28.8 mcg% in the left, 2.3 mcg% in the right adrenal gland), although neither clinical nor laboratory signs of hypercortisolism were present. Spironolactone treatment (100 mg/daily) completely reversed the syndrome of mineralocorticoid excess. After 2 years, patient has normal blood pressure and serum K+ levels.In the male pati...