Results of an International Survey on Spinal Imaging by the ASNR/ASSR/ESNR/ESSR "Nomenclature 3.0" Working Group.

Our goal was to determine if "Nomenclature 2.0," the classification of lumbar disk pathology consensus, should be updated. We conducted a social media and e-mail-based survey on preferences regarding the use of classification on magnetic resonance spine reporting. Members of the European Society of Neuroradiology, European Society of Musculoskeletal Radiology, American Society of Neuroradiology, and American Society of Spine Radiology received a 15-question online survey between February and March 2022. A total of 600 responses were received from 63 countries. The largest number of responses came from Italy and the United States. We found that 71.28% of respondents used Nomenclature 2.0, Classification of Lumbar Disk Pathology. But classification on stenosis is used less often: 53.94% and 60% of respondents do not use any classification of spinal canal stenosis and foraminal stenosis, respectively. When queried about which part of Nomenclature needs improving, most respondents asked for a Structured Reporting Template (SRT), even though 58.85% of respondents do not currently use any template and 54% routinely use a clinical information questionnaire. These results highlight the importance of an updated Nomenclature 3.0 version that integrates the classifications of lumbar disk disease and spinal canal and foraminal stenosis. Further attention should also be directed toward developing a robust endorsed SRT.

Chronic sacroiliac joint dysfunction and CT-guided percutaneous fixation: a 6-year experience.

PURPOSE: Reporting the clinical outcomes, patient satisfaction, and complications following an imaging-guided percutaneous screw fixation in the treatment of sacroiliac joint dysfunction and evaluating the safety and effectiveness of this method. METHODS: We performed a retrospective study on a prospectively gathered cohort of patients with physiotherapy-resistant pain due to sacroiliac joint incompetence that underwent percutaneous screw fixation, between 2016 and 2022 in our center. A minimum of two screws were used in all patients to obtain fixation of the sacroiliac joint, using percutaneous screw insertion under CT guidance, coupled with a C-arm fluoroscopy unit. RESULTS: The mean visual analog scale significantly improved at 6 months of follow-up (p < 0.05). One hundred percent of the patients reported significant improvement in pain scores at the final follow-up. None of our patients experienced intraoperative or postoperative complications. CONCLUSION: The use of percutaneous sacroiliac screws provides a safe and effective technique for the treatment of sacroiliac joint dysfunction in patients with chronic resistant pain.

CT-Guided Posterior Lumbar Interbody Fusion and Distraction. A Case Report.

We performed CT-guided posterior interbody fusion (PIF) with pedicle screw fixation and distraction to treat degenerative lumbar L4-L5 spondylolisthesis with severe left sciatica. The patient was suffering from L4 nerve root compression related to neural foramina stenosis. The dedicated tools to perform a CT-guided percutaneous PIF technique are described. The procedure was easy to apply with a total surgical time of 90 minutes. The neural foramina were investigated by CT scan reconstruction on sagittal plane demonstrating marked widening after PIF application. The left leg pain completely disappeared in two weeks and the patient remained painless at the three month follow-up control. To our knowledge, there are no other papers on CT-guided PIF procedure in the literature.

[Cerebral venous sinuses thrombosis in an infant with supramitral obstructive membrane associated with partial anomalous pulmonary venous return]. / Trombosi dei seni venosi cerebrali in un lattente con membrana sovramitralica ostruttiva associata a ritorno venoso polmonare anomalo parziale.

Cerebral venous thrombosis is quite rare in newborn infants, but probably its incidence is not well evaluated because clinical signs and cerebral echocardiography are not specific. We report the case of an newborn infant with massive cerebral venous thrombosis associated with heart malformation: supramitral ring and partial anomalous pulmonary venous connection in the superior vena cava.

[Brain perfusion ultrasound in atherosclerotic disease. Work in progress]. / Ruolo dell'ecografia perfusionale dell'encefalo nella patologia aterosclerotica. Work in progress.

AIM: The use of low frequency probes allows to overcome the resistance of the skull and evaluate Willis's circle by B-mode and Trans-Cranial Color-Doppler (TCCD) to obtain morphological and functional information related to brain circulation during pathologic conditions. With the new software available today modern technology allow us to measure the transient scattering produced by the rupture of the contrast medium microbubbles and estimate the presence of the contrast medium both in macro- and microcircle. In this way it is possible to appraise parenchymal perfusion. This study aims to assess the intracranial micro- and macrocircle using TCCD with contrast medium (Levovist) and to compare the results with the patients' clinical signs. MATERIAL AND METHODS: We studied 21 subjects aged 45-73 years (mean 68 years) with atheromatous uncomplicated plaques in the internal carotid artery producing varying degrees of stenosis and 10 healthy controls. The examinations were performed using an ATL HDI 3000 ultrasound machine with a Phased Array 3.25 MHz probe. The mechanic index was calibrated to high values to obtain rupture of the microbubbles under insonation. Intensity/time curves of transient scattering were extrapolated for both the cerebral macrocircle and the parenchymal microcircle in the region of interest. RESULTS: The curves were compared with the clinical presentation of the different classes of patients and the results obtained were consistent in showing a clinical pattern of perfusional deficit in subjects with symptoms of chronic brain ischemia. In particular, it was possible to compare the morphologic data relative to the contrast medium decay curves with the patient's clinical condition, confirming the suspicion of cerebral microcircle pathology. CONCLUSION: Thanks to improvements in the software and to the definition of effective algorithms, contrast-enhanced TCCD will be able to provide information on brain perfusion in a simple, inexpensive and relatively non-invasive manner.

Trigeminal neuralgia and cerebellopontine-angle lipoma in a child.

Trigeminal neuralgia and cerebellopontine-angle lipomas are very rare in children. We describe the history and findings of an 8-year-old boy with right trigeminal neuralgia and a lipoma detected by magnetic resonance imaging at the level of the root-entry zone of the right seventh cranial nerve. We propose a possible mechanism of infiltration of the trigeminal rootlets by the lipoma.

Plain film, CT and MRI sensibility in the evaluation of intraorbital foreign bodies in an in vitro model of the orbit and in pig eyes.

Detection and characterization of intraorbital foreign bodies (IFB) is fundamental in acute trauma setting, preventing inflammatory sequelae or complications related to IFB movements when a MRI study is planned. Papers concerning plain film and CT sensibility in IFB detection show controversial results. For this reason we investigated plain film, CT and MRI sensibility in the evaluation of IFB. For an in vitro model, specimens of dry and fresh wood, glass, iron, plastic and graphite were immersed in animal lard and in a 0.9% sodium chloride plus 3.5 g/dl human serum albumin solution. Specimens of different size and nature where also implanted into enucleated pig eyes. Air bubbles were introduced also. Plain film, CT and MRI investigation were performed. Plain films underestimated intraocular IFB as plastic, fresh or dry wooden IFB were not demonstrated. The CT study was always able to depict and differentiate IFB according to the attenuation values. Severe artefacts prevented demonstration of iron, glass and graphite IFB on MRI, whereas plastic or wooden IFB were always detected. Despite radiographs have been suggested as a prerequisite for MR imaging, because our results showed plain film to underestimate radiolucent IFB, we suggest CT as the modality of choice when IFB has to be ruled out.

MR dacryocystography: comparison with dacryocystography and CT dacryocystography.

BACKGROUND AND PURPOSE: Several techniques have been used to image the nasolacrimal system, providing functional (dacryoscintigraphy) or morphologic (dacryocystography, CT dacryocystography [CTD]) information. Using gadopentetate dimeglumine-diluted solution injected into the lacrimal canaliculus or instilled into the conjunctival sac, we compared the sensitivity of MR dacryocystography (MRD) with that of CTD. METHODS: Eleven healthy volunteers and 25 patients affected by primary epiphora (21 patients) or postsurgical recurrent epiphora (four patients) underwent MRD after the topical administration of contrast media or cannulation of the lacrimal canaliculus. The MR imaging findings were compared with irrigation and CTD data. All patients underwent surgical treatment (dacryocystorhinostomy), which served as a standard of reference for confirming the MRD findings. RESULTS: The topical administration of contrast-enhanced saline solution and the injection of contrast-enhanced saline solution after cannulation were always well tolerated. In healthy volunteers, outflow of contrast media was always revealed by MRD. Eight (32%) of 25 patients with epiphora had stenosis proximal to the lacrimal sac revealed by MRD, whereas 17 (68%) of 25 showed a dilated lacrimal sac and nasolacrimal duct stenosis, as confirmed by surgical findings. The findings of MRD after the topical administration of contrast medium and MRD after cannulation of the lacrimal canaliculus were comparable with irrigation or CTD data for all patients except one. CONCLUSION: In patients with epiphora, MR imaging performed after the topical administration of diluted contrast material can reveal stenosis of the lacrimal apparatus and can be added to the standard orbital imaging protocol when lacrimal system involvement is suspected.

Therapeutic considerations in cerebellopontine angle lipomas inducing hemifacial spasm.

Lipoma is a very rare tumour at the cerebellopontine angle. We report a case of incomplete hemifacial spasm, associated with a lipoma involving and compressing both facial and acoustic nerves at their origin in the brainstem. The patient was treated with medical therapy (botulinum toxin A) and surgery. We present a review of the last ten years of the literature, with particular regard to management.

Sequential contrast-enhanced magnetic resonance imaging in the diagnosis of growth hormone deficiencies.

The purpose of the present study was to assess the presence and the time-course of contrast-enhancement in the pituitary gland and pituitary stalk of 24 patients with isolated growth hormone (GH) deficiency and multiple pituitary hormone deficiency. The patients were evaluated clinically (auxological measurements), endocrinologically (spontaneous GH secretion and GH stimulation tests) and with conventional MRI scans. In addition, fast-framing dynamic magnetic resonance imaging (MRI) with Gd-DTPA enhancement was used to quantitate the time course of contrast enhancement within the neurohypophysis, pituitary stalk, postero-superior adenohypophysis and antero-inferior adenohypophysis. In 3 patients without evidence of abnormalities at normal conventional MRI scans (normal anterior lobe and pituitary stalk, normal posterior lobe) and a high response to the GRF provocation test, sequential time-resolved Gd-enhanced MRI demonstrates reduced contrast enhancement in the pituitary stalk. These findings are consistent with impairment in stalk vasculature, presumably located at the level of the portal venous system, and could play a role in the pathogenesis of pituitary hormonal deficiency.

MR imaging of the brain: findings in asymptomatic patients with thalassemia intermedia and sickle cell-thalassemia disease.

OBJECTIVE: The purpose of this study was to evaluate the spectrum of MR findings of the brain in asymptomatic patients affected with thalassemia intermedia or sickle cell-thalassemia disease to prevent brain damage by identifying patients at risk for stroke so that transfusional or pharmacologic treatment could be implemented. SUBJECTS AND METHODS: Forty-one asymptomatic patients who were younger than 50 years and were affected by minor hemoglobinopathies underwent MR imaging of the brain. Ischemic lesions were classified as small, medium, or large and as single or multifocal. Atrophic changes were graded subjectively as mild, moderate, or severe. A grade of brain damage was assigned to every patient. The frequency and severity of brain damage were correlated with the number of sickle-cell crises per year, hemoglobin level, sickling hemoglobin level, platelet count, sex, and age. RESULTS: Of the patients with thalassemia intermedia, 37.5% showed asymptomatic brain damage, and 52% of those with sickle cell-thalassemia disease showed asymptomatic brain damage. In the thalassemia intermedia group, atrophy was always mild and ischemic lesions were generally small (25%) and single (25%). Among the patients with sickle cell-thalassemia disease, 24% had small, 16% had medium, and 12% had large ischemic lesions. Multifocal lesions were twice as common in the patients with sickle cell-thalassemia disease (20%) as in those with thalassemia intermedia (12.5%). Only in the patients with thalassemia intermedia did the frequency of brain damage increase with age. Moreover, brain damage inversely correlated with hemoglobin level in patients with thalassemia intermedia but not in those with sickle cell-thalassemia disease. Brain damage was more severe in patients with sickle cell-thalassemia disease who had more crises per year. CONCLUSION: This study suggests that patients with thalassemia intermedia and those with sickle cell-thalassemia disease may have asymptomatic brain damage. Our results suggest that MR imaging is useful in identifying patients at risk for stroke so that they can be treated with transfusional or pharmacologic therapy.

Bitemporal pseudohemianopia related to the "tilted disk" syndrome: CT, MR, and fundoscopic findings.

We describe a case of the "tilted-disk" syndrome in a patient with a bitemporal field depression (a pseudohemianopia). CT and MR imaging showed thinning and prolapse of the nasal sectors of the posterior walls of the globes and flattening of the temporal portion of the globes.

Evoked potential study and radiological findings in patients with systemic lupus erythematosus.

We performed clinical, radiological (MRI) and neurophysiological (NCV, SEPs, and BAEPs) investigations in 36 unselected patients affected by Systemic Lupus Erythematosus (SLE). Fifteen patients (42%) presented clear neurological events and were considered as definite neuropsychiatric lupus (NPLE); 21 (58%) presented minor subjective complaints or no neurological problems referable to SLE and were considered as no-NPLE. Twenty-three patients (64%) showed neurophysiological abnormalities: 21 (58%) presented central abnormal neurophysiological measurements (including SEP and BAEP values), while 17 (47%) has slowed peripheral nerve conduction. Twenty-six out of 36 patients executed brain MRI examination. High intensity spots (HIS) in deep or subcortical white matter were the most common abnormalities and were present in 19 of the 26 patients (73%). We found that the incidence of neurophysiological and radiological abnormalities did not significantly differ in neurologically symptomatic and asymptomatic patients. Central nervous system impairment evidenced by abnormal N13-20 interpeak intervals (p = 0.05) and HIS (p = 0.01) findings was significantly associated with the presence of cutaneous vasculitis; while peripheral nerve involvement was significantly more frequent in patients with renal failure (p = 0.006).

[Changes in the blood-labyrinth barrier. Assessments by magnetic resonance]. / Alterazioni della barriera emato-labirintica. Valutazioni mediante Risonanza Magnetica.

PURPOSE: Recent progress in magnetic resonance imaging (MRI), with contrast-enhanced and steady-state sequences, allows fine depiction of labyrinth abnormalities related to neoplastic, inflammatory, ischemic, degenerative or traumatic disorders. We examined 488 patients with sensorineural hearing loss, vertigo or dizziness, but normal CT findings, to evaluate MR capabilities in showing labyrinth conditions. MATERIAL AND METHODS: January 1994 to May 1998, four hundred and eighty-eight patients with labyrinthine symptoms were submitted to CT. Sixty-eight of them, with normal CT findings, were also examined with MRI, which was performed using quadrature head or surface coils and a single dose (0.1 mmol/kg) Gd-DTPA administration. Conventional T1 and T2 high resolution SE images were acquired. The labyrinth was studied of 52 patients with normal CT findings and no abnormalities in the cerebello-pontine angle or internal auditory canal. RESULTS: Fourteen of 52 patients (27%) exhibited labyrinth enhancement from tumor (5%), hemorrhage (3%), infection (15%), surgical (2%) or radiosurgical (2%) procedures. GRASS sequences allowed differentiation of mass lesions (e.g., tumors, clots) from other conditions. CONCLUSION: Generally the labyrinth exhibits no contrast enhancement even after a triple Gd-DTPA dose. In inflammatory conditions, enhancement is not always diffuse, as expected, but may be focal. Spontaneous hemorrhages can account for labyrinth enhancement. In neoplastic conditions, enhancement may persist for as many as 6 months, and a mass effect against labyrinthine fluids may appear on GRASS images. Although there are no reports on labyrinthine degeneration after radiation therapy, one of our patients submitted to irradiation 7 years previously, had focal bilateral cochlear enhancement, which suggested a correlation with previous treatment.

[MRI in progressive sensorineural hearing loss]. / L'imaging RMN nelle ipoacusie neurosensoriali progressive.

Magnetic resonance contrast imaging using gadolinium-DTPA and performing new high resolution sequences (Fast Spin-Echo, Spoiled Gradient-Echo) or angiographic sequences (Magnetic Resonance Angiography) allows an excellent visualization of the inner ear and the cerebellopontine angle to be obtained. Furthermore, using sequences obtained with the "steady-state" technique (Gradient Recalled At Steady-State-GRASS, Constructive Interference at Steady-State-CISS), a good analysis of the structures of the membranous labyrinth can be achieved. Based on these diagnostic techniques, we have studied the morphological features of the membranous labyrinth in patients with progressive sensorineural hearing loss due to inner ear malformations, labyrinthitis, neuritis of VII and VIII cranial nerves, degenerative entities such as otosclerosis and Ménière's disease, neoplasms of the cerebellopontine angle, of the inner ear and of the middle ear (glomus tumours, acoustic neuromas, meningiomas, epidermoid tumours, arachnoid cysts and malignant neoplasms).

Neurophysiological and radiological findings in myotonic dystrophy patients.

Somatosensory evoked potentials (SEPs) and brainstem auditory evoked potentials (BAEPs) were recorded in 10 patients with myotonic dystrophy and in 20 sex and age-matched healthy controls. In all patients a brain MRI examination was also performed. In our results, the significantly longer absolute peak latencies of the SEPs and the abnormal increasing of the later components of the BAEPs suggest an involvement of the afferent sensory and central auditory pathways. Brain MRI showed white matter hyperintense lesions (WMHL) in eight patients (80%). No correlations were found between individual abnormal electrophysiological parameters or severity of WMHL and age, age at onset, disease duration or muscular impairment. The total number (SEP + BAEP) of electrophysiological abnormalities significantly correlated with muscular impairment (p < 0.05) and MRI changes (p < 0.005), suggesting a strict pathogenetic linkage between muscular and nervous system alterations in this disease.