Multimodal imaging in the diagnosis and evaluation of intestinal malrotations in adults: a case report.

Midgut malrotation is a congenital anomaly referring to either lack of or incomplete rotation of the fetal intestines around the axis of the superior mesenteric artery during fetal development. It is rare in adulthood and the true incidence is difficult to estimate because most patients are asymptomatic. The diagnosis is usually performed with several radiological and surgical methods. We report a case of a woman who presented with cramp-like abdominal pain localized to the right iliac fossa. The patient underwent abdominal ultrasound, radiological examination without and with contrast, and computed tomography with three-dimensional volume rendering reconstruction. Although small bowel followthrough is often enough to recognize the type of malrotation, using multimodal imaging may offer a better definition of this abnormality with a better definition of the kind of malrotation, by adding additional anatomical information. In our case, the imaging clearly showed malrotation of the small bowel with reverse rotation of the colon. Hence a multimodal imaging strategy proved useful for the diagnosis of intestinal malrotation in an adult afflicted by chronic cramp-like abdominal pain.

Congenital defects of pericardium: case reports and review of literature.

INTRODUCTION: Pericardial defects are a rare condition, generally asymptomatic, due to failure in development of pericardial sac. They are difficult to detect, particularly the complete absence of the pericardium. At present magnetic resonance imaging (MRI) is considered the best performing exam and it could be the first choice in the diagnosis of agenesia of the pericardium. MATERIALS AND METHODS: A comprehensive review of dedicated books and PubMed literature was performed and three clinical cases have been analyzed. RESULTS: We report three cases, one with partial and two with total agenesia of the left pericardium, seen at our Institute and diagnosed at MRI as unexpected findings. DISCUSSION: The diagnosis of a congenital defect of the pericardium is challenging, even for expert radiologists, because this kind of deformity does not provide specific clinical nor conventional radiology findings. Nowadays, the most effective instrument for a certain diagnosis is MRI, interlocked with electrocardiography.

Endovascular treatment with 'kissing' flow diverter stents of two unruptured aneurysms at a fenestrated vertebrobasilar junction.

BACKGROUND AND PURPOSE: Fenestration of the vertebrobasilar junction (VBJ) is a rare condition which may be associated with the presence of aneurysms. The endovascular approach is usually the first-line treatment in these cases since the location of the aneurysm may be unsuitable for a surgical approach. This anatomical variation may even influence the endovascular strategy, particularly in those cases in which the sacrifice of a vessel could be avoided. This paper describes an innovative approach of flow diversion in such challenging situations. METHODS: Two women were admitted after an occasional diagnosis of an aneurysm arising from a fenestrated VBJ. In both cases the endovascular approach was performed with two flow diverter stents and dual antiplatelet therapy was administered for 6 months. RESULTS: Complete exclusion of the two aneurysms was obtained after 6 and 7 months, respectively, and the clinical outcome was excellent. CONCLUSIONS: Endovascular treatment of unruptured aneurysms located on a fenestrated VBJ with flow diverter stents represents a valid therapeutic approach with excellent clinical and radiological outcomes.

Semi-quantitative and qualitative evaluation of pial leptomeningeal collateral circulation in acute ischemic stroke of the anterior circulation: the Careggi Collateral Score.

INTRODUCTION: The imaging of ischemic penumbra in acute stroke is a debated issue and establishing commonly accepted criteria is difficult. Computerized tomography-perfusion studies conducted in animals have showed that the modifications occurring in the brain parenchima are part of a dynamic and progressive process involving the microcirculation. The purpose of this paper is to propose a new angiographic classification of collateral circulation in patients with acute ischemic stroke, with a possible correlation with the clinical outcome. MATERIALS AND METHODS: The basal angiograms of 57 patients with acute ischemic stroke is the territory of anterior circulation secondary to a major occlusion, who underwent endovascular treatment, were retrospectively reviewed and collaterals were classified according to our novel Careggi Collateral Score in 6 grades (0-6). The clinical outcome after 3 months was evaluated with modified Rankin Scale. A ROC (receiver operating characteristic) curve analysis identified a cut-off value of 1. RESULTS: Patients with favorable collateral circulation (grades 2-5) showed a significant correlation with good clinical outcome (modified Rankin Scale < or = 2). CONCLUSIONS: The Careggi Collateral Score resulted a useful tool to evaluate the chance of obtaining a favorable result with endovascular treatment in patients with acute ischemic stroke in the anterior circulation secondary to the occlusion of a major artery.

Anatomical variations of the posterior circulation: case reports and a review of literature.

INTRODUCTION: The intracranial vascular anatomical variations, although rare, represent a interesting field of research, since many anomalous variants are possible and in most cases they remain asymptomatic. The capability of the cerebral circulation to adapt to several flow changes is confirmed by the fact that in several cases these anatomical variation compensate for an eventual unsuccessful development of the normal circulation, expecially in the posterior section of cerebral circulation. MATERIALS AND METHODS: A comprehensive review of PubMed literature was performed and three clinical cases have been analyzed. RESULTS: Several angiographic and MR-angiography reports have been evaluated, regarding general and specific anatomical variants of the posterior circulation. DISCUSSION: Although rare, the anatomical variations of the posterior intracranial circulation represent an interesting field of investigation in order to achieve a better comprehension of the embryological development of the circulatory system.

Magnetic resonance imaging of the shoulder anatomy.

Magnetic Resonance represents the best method for shoulder study, since it enables us to emphasize all the parts making part of this area thanks to high anatomical details and a comprehensive view of it. Conventional radiographic techniques provide only limited evaluation of soft-tissue anatomy; ultrasonography, on the other hand, allows the visualization of tendons, synovial spaces and muscle fascicles but it is shown to be unfit above all for osseous structure evaluation: TC, finally, is not being employed at present in shoulder study.