Diabetic striatopathy: an updated overview of current knowledge and future perspectives.

PURPOSE: Diabetic striatopathy (DS) is a rare complication of poorly controlled diabetes mellitus (DM), characterized by hyperglycemia associated with chorea/ballism and characteristic reversible basal ganglia abnormalities on computed tomography (CT) and/or magnetic resonance imaging (MRI). We propose a narrative review of the literature on this topic, currently unknown to most, and about which physicians should be aware. We intend to summarize, critically review, and take to mean the evidence on this disorder, describing its typical features. METHODS: We searched Pubmed for English-language sources using the following keywords in the title and the abstract: diabetic striatopathy, hyperglycemic non-ketotic hemichorea/hemiballism, chorea/hemichorea associated with non-ketotic hyperglycemia, diabetic hemiballism/hemichorea, chorea, hyperglycemia, and basal ganglia syndrome. We collected scientific articles, including case reports, reviews, systematic reviews, and meta-analyses from the years 1975 to 2023. We eliminated duplicate, non-English language or non-related articles. RESULTS: Older Asian women are more frequently affected. Suddenly or insidiously hemichorea/hemiballism, mainly in the limbs, and high blood glucose with elevated HbA1c in the absence of ketone bodies have been observed. Furthermore, CT striatal hyperdensity and T1-weighted MRI hyperintensity have been observed. DS is often a treatable disease following proper hydration and insulin administration. Histopathological findings are variable, and no comprehensive hypothesis explains the atypical cases reported. CONCLUSION: DS is a rare neurological manifestation of DM. If adequately treated, although treatment guidelines are lacking, the prognosis is good and life-threatening complications may occur occasionally. During chorea/hemiballism, we recommend blood glucose and HbA1c evaluation. Further studies are needed to understand the pathogenesis.

Sociocultural overview and predisposing factors of body art in a health promotion perspective: survey on a sample of Italian young adults.

Background: The body art (tattoos, body piercing and other aesthetic practices) is increasing at global level and involves different aspects of public health, from epidemiological feature to cultural and psychosocial determinants and regulatory issues. The study is aimed at estimating the prevalence of tattooed and pierced in youth, focusing on emerging profiles. Study design: A cross-sectional study has been conducted on 575 students at the first year of degree courses of an Italian University. Methods: Students were asked to fill an online questionnaire. Logistic regression models were evaluated in order to identify predictive factors and determinants of practice (tattoos, piercing, body art). Results: The 41.9% of participants underwent at least one body art intervention, with a higher prevalence in females. Multivariate logistic regression suggested an association of body art practice with type of school and university course, as well as lifestyle characteristics (smoking, alcohol abuse). In addition, the intention to undergo to body art intervention in the future appeared significantly higher in women and more frequent in apparently 'protected' categories such as medical students and non-problematic alcohol users. Conclusions: The study confirmed the importance of the surveillance and social and behavioural research on body art practice and suggested different health promotion perspectives, such as early intervention towards adolescents and late intervention towards young adults belonging to lesser risky population groups.

Evaluation of Gd-enhancement in brain MR of multiple sclerosis: image subtraction with and without magnetization transfer.

The aim of our study was to test the possibility of using image subtraction in detecting enhancing lesions in brain MR scans with and without magnetization transfer (MT) in multiple sclerosis (MS). Ten MS patients underwent 1.5-T MR imaging of the brain with spin-echo T1-weighted sequences with and without MT, repeated after 0.1 mmol/kg of an usual two-compartment paramagnetic contrast agent (Gadoteridol, Gd-HP-DO3A). Precontrast images were subtracted from postcontrast. Enhancing lesions were counted on the postcontrast images only (post-Gd), comparing pre- and postcontrast images by direct visual control (pre/post-Gd), and on the subtracted images (SI) only. Without MT, 36 enhancing lesions were counted on post-Gd, 36 on pre/post-Gd, and 59 on SI; using MT, 69, 52, and 50, respectively. Significant differences were found for pre/post-Gd without MT vs SI without MT ( p=0.028) and vs pre/post-Gd with MT ( p=0.012) as well as for pre/post-Gd with MT vs post-Gd with MT ( p=0.028). With pre/post-Gd, MT allowed the detection of 1.6 enhancing lesions per patient more than without MT. Whereas the SI without MT allow the detection of an increased number of enhancing lesions, SI with MT do not. An off-site final assessment allowed calculation of sensitivity and positive predictive value as follows: without MT were 63 and 94% (post-Gd), 67 and 100% (pre/post-Gd), 96 and 88% (SI); and with MT were 93 and 73% (post-Gd), 96 and 100% (pre/post-Gd), 91 and 98% (SI), respectively. Thus, SI seem to increase the sensitivity without MT; moreover, they could be used to correct the pseudoenhancement that impair post-Gd images with MT.

Volume measurement with magnetic resonance imaging of hippocampus-amygdala formation in patients with anorexia nervosa.

The purpose of our work was to evaluate the volume of hippocampus-amygdala formation (HAF) in patients with anorexia nervosa (AN), being this structure a crucial target for the glucocorticoid action in the adaptative stress-response. AN patients have biochemical hypercortisolism associated to normal ACTH levels, but do not develop the characteristic clinical features of glucocorticoid hypersecretion. Furthermore, in these patients cortisol levels usually do not suppress after dexametasone challenge. Twenty AN females (aged 30.0+/-5.1) with 10.5+/-4.2 yr of disease underwent a brain magnetic resonance (MR) examination during the recovery phase; an age-matched control group (CG) of 20 healthy female volunteers was also studied. Two interleaved T1-weighted spin-echo sequences for 46 contiguous 2-mm coronal slices (pixel 0.98(2) mm) were used. The volumes of both right and left HAFs were calculated with manual contouring from the third ventricle to the Sylvian aqueduct. IGF-I, T3, gonadotropins, 24-h urine free cortisol, and BMI were obtained for both patients (on admission and on present evaluation) and CG. Mann-Whitney, Wilcoxon and Spearman tests were used. AN patients showed a significant (p=0.0001) reduction of total (right plus left) HAF volume (6.6+/-1.3 cm3) when compared with CG (8.9+/-1.1). No significant difference was found between right and left HAF in both patients and CG. In AN patients, no significant correlation was found between the HAF and all the hormonal parameters or BMIs, while a trend towards significance was observed with duration of the disease (r=-0.398; p=0.082). MR imaging demonstrated a significant volume reduction o

[Brain magnetic resonance with magnetization transfer in multiple sclerosis. Lesion hyperintensity before and after intravenous gadolinium administration]. / Risonanza Magnetica encefalica con trasferimento della magnetizzazione nella sclerosi multipla. Iperintensità lesionale prima e dopo somministrazione endovenosa di Gadolinio.

PURPOSE: To evaluate lesion contrast enhancement in brain magnetic resonance (MR) images with and without magnetization transfer pulse (MT) in patients affected with multiple sclerosis (MS). MATERIAL AND METHODS: Ten patients affected with relapsing-remitting MS underwent a 1.5-T (Magnetom Vision, Siemens) MR examination with T1-weighted spin-echo sequences without MT (TR/TE = 630/14 ms) and with MT (840/14 ms) using the following common parameters: 21 para-axial slices (thickness 5 mm, 10% gap); matrix 256 x 256; field of view 25 cm (rectangular 5/8); 2 excitations. The postcontrast sequences with and without MT were acquired in a randomized order, starting 5 minutes after the intravenous injection of 0.1 mmol/kg Gadoteridol (ProHance, Bracco). The images were blindly evaluated in four separate sessions: only the postcontrast images with MT (post-Gd with MT); only the postcontrast images without MT (post-Gd without MT); comparing the pre- and postcontrast images with MT (pre/post-Gd with MT); comparing the pre- and postcontrast images without MT (pre/post-Gd without MT). The number of hyperintense areas referred to contrast enhancement and the evaluation time were measured for each session. The Wilcoxon test was used for statistical analysis. RESULTS: The number of areas referred to lesion contrast enhancement per patient were as follows: post-Gd with MT, 6.9 +/- 6.8 (mean +/- standard deviation) (range 1-24); post-Gd without MT, 3.6 +/- 4.3 (0-14); pre/post-Gd with MT, 5.2 +/- 6.1 (1-21); pre/post-Gd without MT, 3.6 +/- 4.9 (0-16). A nonsignificant difference was found for the comparison between post-Gd without MT and pre/post-Gd without MT while significant differences were found between post-Gd with MT and pre/post-Gd with MT (p = .028), pre/post-Gd without MT and pre/post-Gd with MT (p = .012), as well as between post-Gd without and post-Gd with MT (p = .008). The mean evaluation time for the different sessions was always less than a minute, ranging from 33 seconds for pre/post-Gd without MT to 51 seconds for post-Gd with MT. CONCLUSIONS: The postcontrast sequence obtained with the MT pulse detects more active lesions than the postcontrast sequence without MT. However, the comparison with the plain images with the MT pulse is mandatory to exclude pseudoenhancement foci, i.e. hyperintense areas already present in the precontrast images with the MT pulse, without disruption of the blood-brain barrier. The post-Gd without MT sequence needs not be compared with the precontrast images without MT. Differences in evaluation time are practically negligible.

Double-contrast magnetic resonance examination of ulcerative colitis.

The aim of our work was to propose a double-contrast magnetic resonance examination (DCMRE) in the follow-up of ulcerative colitis (UC), comparing this new technique with X-ray double-contrast barium enema (DCBE). After preparation with colon-cleansing regimen used for DCBE, six UC patients and six control subjects underwent a 1.5-T examination: supine position, coronal and axial fat-spectral-saturation breath-hold gradient-echo T1-weighted sequences after intravenous hypotonization and 1500-2000 cc air insufflation. Without evacuating the primarily insufflated air, the same images were acquired after endorectal administration of negative superparamagnetic contrast agent (600 cc) and intravenous administration of positive paramagnetic contrast agent (0.2 mmol/kg). All patients had undergone DCBE in the four preceding weeks. We found significant increase in wall thickness of UC affected vs apparently unaffected segments (p = 0.0425) and vs CG (p = 0.0447), significant increase in enhancement percent of UC affected vs apparently unaffected segments (p = 0.0161) and vs CG (p = 0.0185), and no significant difference for enhancement percent of UC unaffected segments vs CG. DCMRE and DCBE localized the UC extension at the same sites in all patients. Double-contrast MR examination time was 20-30 min. This new method could be used in follow-up of UC patients.

Cranial MRI in ataxia-telangiectasia.

We examined five males with laboratory-confirmed ataxia-telangiectasia (AT), aged 9-28 years, several times by MRI (9 examinations: 5 at 0.15 T, 3 at 0.5 T, 1 at 1.5 T). Intermediate, T1-, T2- and T2*-weighted spin-echo and gradient-echo sequences were performed. All patients showed vermian atrophy, enlarged fourth ventricle and cisterna magna; four showed cerebellar hemisphere atrophy; two enlarged infracerebellar subarachnoid spaces and four patients had sinusitis. No focal areas of abnormal signal were seen in the brain, diffuse high signal was found in the central cerebral white matter of the oldest patient. AT is an important human model of inherited cancer susceptibility and multisystem ageing; as in xeroderma pigmentosum and other "breakage syndromes", ionising radiation should be avoided. When imaging is necessary, MRI should be preferred to CT in patients known or suspected to have AT and those with undefined paediatric ataxias of nontraumatic origin. If atrophy of only the cerebellum, especially the vermis, is noted, laboratory research should be performed to confirm the diagnosis of AT.

[Magnetic resonance tomography compared to computed tomography in the intracardiac spread of hepatocarcinoma]. / Tomografia a risonanza magnetica a confronto con tomografia computerizzata nell'estensione intracardiaca di un epatocarcinoma.

A cirrhotic patient with inferior cava and right atrium-ventricular invasion by hepatic tumor was studied with transthoracic echocardiography (TTE), computerized tomography (CT) before and after contrast agent bolus iv, ECG-gated magnetic resonance imaging (MRI). Obesity obstacled abdominal echotomographic study; esophageal varices were relative contraindication to transesophageal echocardiography (TEE). The resolutive diagnosis was possible thanks to MRI which documented the spatial continuity among hepatic tumor, intracaval neoplastic thrombus and intracardiac mass. TTE can be considered the first step in case of suspected cardiac masses, but it is sometimes limited by the thorax conformation and not always discriminant. TEE is semi-invasive with important contraindications. CT is limited by the only axial or para-axial scans with low quality reconstructions, worsened in these cases by respiratory and cardiac movements. MRI can be considered the second step in the imaging of cardiac masses, immediately and directly after the echocardiographic techniques.