Double micro-guide-wire technique to facilitate microcatheter navigation through tortuous intracranial vasculature.

We report a case in which navigation of the micro catheter (Headway 027) with the conventional single microwire technique became impossible because of the difficult intracranial vascular anatomy. In order to achieve access, we used two Terumo 012 inches micro guide-wires with a 45° angle inside a single micro catheter. The manoeuver was easy and can be reproduced in specific and challenging cases.

Intracerebral schwannoma: CT and MR findings.

A case of intracerebral schwannoma in a 19-year-old man is reported. CT and MR findings were nonspecific, suggesting a primary glioma. The histologic features were of schwannoma.

Diffuse leptomeningeal gliomatosis with osteoblastic metastases and no evidence of intraaxial lesions.

An autopsy-proved case of cerebral and medullary leptomeningeal gliomatosis and diffuse osteoblastic metastases without evidence of intraaxial tumor is described. MR findings included diffuse thickening of the cerebral and medullary leptomeninges on T1-weighted, proton density-weighted, and T2-weighted images and abnormal enhancement of the sulci and cisterns of the cerebrum, brain stem, cerebellum, and medulla on postcontrast T1-weighted images. MR also showed several areas of replacement of the normal bone marrow of the skull. No intraaxial lesion was seen.

Magnetic resonance imaging (MRI) of the brain in SLE: ECLAM and SLEDAI correlations.

Twenty-one unselected SLE patients were examined with Magnetic Resonance Imaging (MRI) for cerebral areas of high signal intensity (HSI). Nine patients (42.9%) had HSI and 6 (28.6%) had large (> or = 6 mm) lesions suggestive of cerebral involvement. Despite the lack of correlation among these lesions and clinical or immunological features, the SLEDAI and ECLAM indices were correlated to the number of large lesions (p < 0.002). Our findings suggest that brain MRI may be useful in the evaluation of SLE patients, not only those with evident neurologic symptoms, but also asymptomatic subjects with high disease activity indices.

Neuronal migrational disorders in children with epilepsy: MRI, interictal SPECT and EEG comparisons.

Single-photon emission computed tomography (SPECT) is being increasingly used in the investigation of children with epilepsy and may provide insights into congenital malformations. We analyzed the interictal 99Tc-HMPAO-SPECT in a series of seven children with developmental disorders of the neocortex, each of them representing a prototype of cerebral dysgenesis, such as lissencephaly, pachygyria, opercular dysplasia, polymicrogyria, nodular heterotopia and band heterotopia. The patients studied were selected among 22 epileptic children with neuronal migrational disorders (NMDs). Interictal SPECT hypoperfusion was observed in the area homologous to MRI findings in all the examined children. In three patients low perfusion was also present in the opposite hemisphere, probably due to functional involvement or related to an underlying microdysgenesis, not revealed by structural imaging. EEG features were in agreement with low perfusion areas, both anatomically and functionally, in all children. In one patient hypoperfusion area differed from that revealed by MRI and EEG. Ictal SPECT has been considered a useful tool for accurately locating the epileptic focus. Nevertheless, interictal brain perfusion studies, together with proton magnetic resonance spectroscopy, may play an important role in detecting anatomic substrate in developmental disorders of the neocortex.

[The basic concepts of the use of magnetic resonance in neuropediatrics]. / Concetti base sull'impiego della Risonanza Magnetica in neuropediatria.

Before the development of X-ray computed tomography (CT) and magnetic resonance imaging (MRI), it was not possible to analyze normal brain maturation in vivo. Only autopsy studies were really able to show changes in the maturing brain, nevertheless these studies did not represent an homogeneous and correct appearance of the sample population by the various causes of infant death. MR shows gross morphologic changes in the maturing brain, and the high contrast resolution of MR scans permits highly sensitive assessment of white matter changes. Changes of white matter maturation are seen best on T1 weighted images (TR = 600 msec., TE = 15 msec., SL = 4, AL = 2, FOV = 200 mm, 1 acquisition), specially on sagittal scans, during the first 6 months of life and the second echo of T2 images (TR = 2500 msec., TE = 40-50 msec., FOV = 200 mm, 1 acquisition), between the ages of 6 and 18 months. The most important factor in obtaining high quality MR images in children is adequate sedation. In this report the authors explain MR imaging of white matter changes in a period from birth to 18 months of age of normal postnatal brain development.

[The role of imaging technics in assessing laryngeal neoplasms]. / Ruolo delle tecniche ad immagini nella valutazione delle neoplasie del laringe.

In this work the most frequent malignant diseases of the larynx are been evaluated. The authors want to emphasize the importance of CT and MRI to perform a careful assessment of the disease to choose an adequate surgical therapy.

[Tumors of the oral cavity, oropharynx and salivary glands. Role of TC and MRI in neoplasm staging]. / Tumori del cavo orale, dell'orofaringe e delle ghiandole salivari. Ruolo della TC e della RM nella stadiazione.

MRI and CT have an important role in the study of neoplasms of oropharynx, oral cavity and salivary glands. They play an invaluable role in the diagnosis and in the evaluation of the tumor growth. Moreover MRI allows multiplanar studies with the advantage of a more sensitive evaluation of the extension of the lesions.

[Tumors of the nose, paranasal sinuses and facial bones: the role of computerized tomography and MRI in the assessment of the damage]. / Tumori del naso, dei seni paranasali e delle ossa facciali: apporto della tomografia computerizzata e della risonanza magnetica nell'accertamento della estensione della malattia.

The authors examine the use of CT and MR comparatively in tumours of nose, paranasal sinuses and facial bones. Both CT and MR are much more useful to assess the real extent of the pathology than to give specific diagnose. The resolution of the images and the possibility of examining them on many different planes give evident advantage to MR as regards the evaluation of tumors in this region. Nevertheless, CT with bone algoritme gives better details about bone structure.

[Role of magnetic resonance in the evaluation of testicular diseases]. / Ruolo della risonanza magnetica nella valutazione della patologia del testicolo.

The above paper was intended to evaluate the usefulness of MRI in the study of pathologies involving the testis, on the basis of the authors' experience and of the relevant literature. Pathologies considered included cryptorchidism, torsion of the spermatic cord, epididymitis, orchitis, and testicular tumors. MRI proved very useful in cryptorchidism, thanks to the multiple planes and good contrast resolution between different tissues. It also yields valuable information allowing to distinguish between malignant transformation of the retained testicle and its fibrotic involution. In malignant pathologies, MRI is useful for differential diagnosis between seminomatous and non-seminomatous tissues, while for purposes of staging its accuracy is only 36% but is nevertheless superior to that of U.S. (45%). In the case of other pathologies, MRI findings are non specific, and the technique should therefore be employed only when U.S. findings are unsatisfactory.

[Current role of computerized tomography and prospectives of the use of magnetic resonance in the diagnosis of aortic abdominal aneurysms and evaluation of their complications]. / Ruolo attuale della tomografia computerizzata e prospettive d'impiego della risonanza magnetica nell'accertamento degli aneurismi dell'aorta addominale e nella valutazione delle complicanze.

In this work we discussed the role of conventional radiology, ultrasonography (US), angiographic study, CT scan and MR imaging in the diagnosis of abdominal aortic aneurysms and their complications. US is the most suitable technique for screening and follow-up study of aortic aneurysms. Unfortunately it is not so reliable in the study of visceral arteries and in fat patients. Aortic angiography is the most useful method for the study of visceral arterial branches, but it does not show the phlogistic changes as well as the peripheral thrombotic alterations within the lesion. TC scan is also a useful technique in the study of aortic aneurysm, although it is not so accurate in detecting the visceral arterial branches. Finally, we think that MR imaging is the most reliable method for the diagnosis of aortic aneurysm. Movement artifact and lack of information due to the poor visualization of calcifications are still the principal limits of this technique.

[Role of CT and MR in the assessment of lumbar degenerative disk disease]. / Ruolo della TC e della RM nella valutazione della patologia degenerativa discale lombare.

The application of CT and MR techniques for the evaluation of degenerative disease of lumbar disk is illustrated in this work. A critical review of the literature was done.

[Tumors of the temporal bone and the cerebellopontine angle. Diagnosis, characterization and assessment of extension by using imaging technics]. / Tumori dell'osso temporale e dell'angolo ponto-cerebellare. Diagnosi, caaratterizzazione e bilancio di estensione con le tecniche ad immagini.

We discuss in this paper the reliability of neuroimaging techniques in the diagnosis of neoplastic masses of the posterior-lateral skull base. We also discuss the role of TC and MRI in the evaluation of the extension pattern of these masses.

[Magnetic resonance angiography in the study of cervical and endocranial vascular pathology]. / Angiografia a risonanza magnetica nello studio della patologia vascolare cervicale ed endocranica.

The principles of MR angiography techniques for the detection of vascular anatomy are discussed in this review. We underlined the possibilities and limits of this technique with its advantages and disadvantages. We also discuss the applications of MR angiography in diagnosing of cerebrovascular or neoplastic diseases. Finally we stress the role of MR angiography in clinical practice, and its reliability, in comparison with digital angiography, conventional angiography, and spiral CT.

[Diffusion and perfusion studies with magnetic resonance imaging in cerebral ischemia]. / Studi di diffusione e perfusione con risonanza magnetica ad immagini nell'ischemia cerebrale.

The results of diffusion-perfusion RM studies in cerebrovascular diseases are reviewed in this paper. We discussed the role of these techniques for the understanding of the pathogenesis of cerebral ischemia, in experimental studies as well as in humans and their future application in diagnostic clinical trials, for early detection and management.

[Magnetic resonance spectroscopy]. / Spettroscopia a risonanza magnetica.

Although the usefulness and feasibility of MR spectroscopy in clinical practice has not been proven, this technique has shown to be useful for the understanding of pathogenetic mechanisms of several diseases. In this work we reviewed the most important fields of application of MR spectroscopy and discussed its diagnostic potential.

[Aortic dissection: the role of diagnostic imaging, with special reference to magnetic resonance imaging and its implications in the pathogenesis]. / Dissezione aortica: ruolo della diagnostica per immagini con particolare riferimento alla risonanza magnetica ed alle sue implicazioni nella patogenesi.

The aim of this work was to evaluate the usefulness of angiography, CT scan and MR imaging in the diagnosis of aortic dissection, on the basis of the authors' experience and literature review. Angiographic study is still considered the first choice technique in the diagnosis of aortic dissection, although it is considered not completely safe. CT scan allows to note the early thickening of the vessel walls (due to intraparietal bleeding) and the presence of calcifications in the thrombosed portion of the lesion. MR study allows multiplanar study of the lesions without contrast medium, and best visualization of subendothelial bleeding in dissections without intimal lesion.

[Erdheim-Chester disease: a non-Langerhans cell histiocytosis. A clinical-case and review of the literature]. / La malattia di Erdheim-Chester una istiocitosi a cellule non Langerhans. Rewiew della letteratura e descrizione di un caso clinico.

We make a retrospective evaluation of clinical and radiologic features, treatment, and outcome of Erdheim-Chester disease, a rare non-Langerhans cell histiocytosis. We report a case of Erdheim-Chester disease and review 60 cases from the literature. These cases are consider to have Erdheim-Chester disease when they have either typical bone radiographs (symmetrical long bones osteosclerosis) and/or histologic criteria disclosing histiocytic infiltration with distinctive immunohistochemical phenotype of the non-Langerhans cell histiocytes with positive staining for CD68 and negative staining for S-100 protein and CD1a. Our patient undergoes chemiotherapy according to the LCH-II stratification and therapy plan (Vinblastine, Etoposide and Prednisone) and thereafter receives Carboplatin and Etoposide, and Somatostatin. She is alive and clinically well 33 months after onset of symptoms and the lesions don't appear to progress at imaging examinations. In conclusion, Erdheim-Chester disease may be confused with Langerhans cell histiocytosis as it sometimes shares the same clinical (exophthalmos, diabetes insipidus) or radiologic (osteolytic lesions) findings. However, the characteristics radiological pattern of Erdheim-Chester disease together the immunohistochemical phenotype of hystiocytic infiltration supports the theory that Erdheim-Chester disease is a unique disease entity distinct.

[The role of TC and MRI in the identification, characterization and staging of tumors of the spinal vertebrae]. / Ruolo della TC e della RM nella identificazione, caratterizzazione e stadiazione della patologia neoplastica della colonna vertebrale.

The early detection and characterization of primary and metastatic spinal bone tumors permits early and appropriate surgical or nonsurgical intervention directed toward preserving life and function. The sensitivity and multiplanar capabilities inherent in Magnetic Resonance imaging make it the imaging procedure of choice in detecting and characterizing a spinal bone lesion. Spiral Computed Tomography with multiplanar reconstruction may be a useful supplementary procedure, especially when detailed bony anatomy, particular of the posterior elements, is required for surgical intervention. Plain films play little if any role in modern imaging. The may be used as screening procedures in situations in which MR and CT are not available.

[Magnetic resonance in AIDS-related encephalopathy]. / La risonanza magnetica nella encefalopatia da AIDS.

Fifty-eight patients with AIDS disease were studied with MR imaging in the aim of detecting the grade of brain involvement. The examinations were performed with a 1.5 Tesla magnet. Thirty-seven showed white matter lesion (63.5%), twenty-five patients showed cerebral atrophy (43%), in eight patients the MR appearance was consistent with toxoplasmosis infection (13.5%), two patients showed a linfoma (3.4%) and two patients micrococcosis (3.4%). Seventeen out of the thirty-seven patients with white matter disease showed focal well circumscribed lesion (46%), while twenty showed diffuse involvement. Between the twenty-five patients with cerebral atrophy, twelve showed a prevalence of the cortical involvement and eight a subcortical atrophy. In five patients a concomitant, cortical and subcortical atrophy was found. Between the eight patients with neurotoxolesion and two of them a widespread encephalitis picture. The MR appearance of the two limphomas was that of periventricular, space occupying, masses. In two patients with micrococcis a nodular aspect of leptomeningeal lesions was found.