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1.
Artículo en Inglés | MEDLINE | ID: mdl-35565111

RESUMEN

BACKGROUND: The aim of our observational study is to compare the therapeutic efficacy of combined treatment of oxygen-ozone therapy and oral treatment with alpha-lipoic acid (ALA) + palmitoylethanolamide (PEA) and myrrh in patients with peripheral neuropathic pain (sciatica) on radicular disc conflict from disc herniation and the results obtained with oxygen-ozone treatment alone. METHODS: We enrolled 318 patients with the neuroradiological diagnosis of disc herniation performed with computed tomography (CT) or magnetic resonance imaging (MRI) and symptoms characterized by low back pain complicated by sciatica, which we divided into two groups. Group A was composed of 165 patients who were treated only with oxygen-ozone therapy with CT-guided intraforaminal technique, while the remaining 153 (Group B) have undergone combined oral treatment with ALA + PEA and myrrh. Follow-up visits for the evaluation of the clinical outcome of the treatment were conducted after 60 ± 8 days using a modified version of McNab's method. RESULTS: At the clinical check-up, 126/165 patients included in Group A had a complete remission of pain (76.4%), while in Group B, 119/153 (77.8%) had a complete remission of pain. CONCLUSION: The results highlight how the treatment associated with ozone therapy and oral administration of alpha-lipoic acid + palmitoylethanolamide and myrrh is preferred over the simple treatment with only ozone in such patients in the phase of greatest acuity of the disease, where the pain appears to be better controlled.

2.
Eur J Radiol Open ; 8: 100389, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34934778

RESUMEN

Low back pain (LBP) is a common disorder affecting an increasing number of people worldwide, whose diagnosis is focused on the identification of triggering causes. First line therapy usually starts from conservative approaches, whereas second line treatments include a spectrum of minimally invasive techniques, before resorting to more invasive surgical approaches. Among minimally invasive techniques, percutaneous oxygen-ozone injections represent one of the most common and cost-effective procedures. Aim of this study is to provide a metanalysis on literature evidences on percutaneous oxygen-ozone injections, comparing image-guided to non-image-guided techniques for LBP treatment. Imaging-guided procedures showed better performances compared to non-image-guided techniques based only on anatomical landmarks, with higher therapeutic efficacy and lower age-related variability in clinical results.

3.
J Cardiovasc Dev Dis ; 8(10)2021 Oct 03.
Artículo en Inglés | MEDLINE | ID: mdl-34677195

RESUMEN

Major adverse cardiac events, defined as death or myocardial infarction, are common causes of perioperative mortality and major morbidity in patients undergoing non-cardiac surgery. Reduction of perioperative cardiovascular risk in relation to non-cardiac surgery requires a stepwise patient evaluation that integrates clinical risk factors, functional status and the estimated stress of the planned surgical procedure. Major guidelines on preoperative cardiovascular risk assessment recommend to establish, firstly, the risk of surgery per se (low, moderate, high) and the related timing (elective vs. urgent/emergent), evaluate the presence of unstable cardiac conditions or a recent coronary revascularization (percutaneous coronary intervention or coronary artery bypass grafting), assess the functional capacity of the patient (usually expressed in metabolic equivalents), determine the value of non-invasive and/or invasive cardiovascular testing and then combine these data in estimating perioperative risk for major cardiac adverse events using validated scores (Revised Cardiac Risk Index (RCRI) or National Surgical Quality Improvement Program (NSQIP)). This stepwise approach has the potential to guide clinicians in determining which patients could benefit from cardiovascular therapy and/or coronary artery revascularization before non-cardiac surgery towards decreasing the incidence of perioperative morbidity and mortality. Finally, it should be highlighted that there is a need to implement specific strategies in the 2019 Coronavirus disease (COVID-19) pandemic to minimize the risk of transmission of COVID-19 infection during the preoperative risk assessment process.

5.
Diagnostics (Basel) ; 11(8)2021 Jul 21.
Artículo en Inglés | MEDLINE | ID: mdl-34441245

RESUMEN

(1) Although guidelines about the use of MRI sequences for Multiple Sclerosis (MS) diagnosis and follow-up are available, variability in acquisition protocols is not uncommon in everyday clinical practice. The aim of this study was to evaluate the real-world application of MS imaging guidelines in different settings to clarify the level of adherence to these guidelines. (2) Via an on-line anonymous survey, neuroradiologists (NR) were asked about MRI protocols and parameters routinely acquired when MS patients are evaluated in their center, both at diagnosis and follow-up. Furthermore, data about report content and personal opinions about emerging neuroimaging markers were also retrieved. (3) A total of 46 participants were included, mostly working in a hospital or university hospital (80.4%) and with more than 10 years of experience (47.9%). We found a relatively good adherence to the suggested MRI protocols regarding the use of T2-weighted sequences, although almost 10% of the participants routinely acquired 2D sequences with a slice thickness superior to 3 mm. On the other hand, a wider degree of heterogeneity was found regarding gadolinium administration, almost routinely performed at follow-up examination (87.0% of cases) in contrast with the current guidelines, as well as a low use of a standardized reporting system (17.4% of cases). (4) Although the MS community is getting closer to a standardization of MRI protocols, there is still a relatively wide heterogeneity among NR, with particular reference to contrast administration, which must be overcome to guarantee an adequate quality of patients' care in MS.

6.
Eur J Radiol Open ; 8: 100369, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34307789

RESUMEN

BACKGROUND: Vascular lesions of the spinal cord are rare but potentially devastating conditions whose accurate recognition critically determines the clinical outcome. Several conditions lead to myelopathy due to either arterial ischemia, venous congestion or bleeding within the cord. The clinical presentation varies, according with the different aetiology and mechanism of damage. PURPOSE: The aim is to provide a comprehensive review on the radiological features of the most common vascular myelopathies, passing through the knowledge of the vascular spinal anatomy and the clinical aspects of the different aetiologies, which is crucial to promptly address the diagnosis and the radiological assessment.

8.
Insights Imaging ; 12(1): 14, 2021 Feb 11.
Artículo en Inglés | MEDLINE | ID: mdl-33575851

RESUMEN

OBJECTIVE: To promote a better radiological interpretation of spine degeneration, a consistent standardization of the acquisition, interpretation and description of Magnetic Resonance Imaging (MRI) l findings. MATERIALS AND METHODS: In order to achieve this objective, a consensus among experts in imaging of degenerative spine disease (DSD) from Italian radiological societies (SIRM-Italian Society of Radiology, AINR-Italian Association of Neuroradiology) was achieved. The representatives of the Italian inter-societal working group examined the literature produced by European/American task forces on optimizing the study sequences, classification of degenerative disc changes, spondylo-arthrosis, osteochondrosis, synovial and ligament pathologies of the spinal column, and on canal and foraminal stenosis. The document-resulted from the consensus between experts-was then presented to the scientific societies of Neurosurgery (SINCH) and Orthopedics and Traumatology (SIOT) for their approval. RESULTS: This position paper presents a proposal for an optimized MRI protocol for studying DSD and provides a glossary of terms related to this pathology and indications on their use. The international terminological recommendations have been translated and adapted to the Italian language and clinical practice and clinical cases have been used to illustrate some of the main classifications. CONCLUSIONS: This revision of international DSD guidelines/recommendations and consensus made it possible to (1) update the nomenclature to international standards and (2) harmonize the MRI protocol and description of radiological findings, adapting both (1, 2) to the Italian context. With this position paper we intend to contribute to an improvement of the communication among doctors and between physicians and their patients as well as the quality of the radiological reports.

9.
Eur Radiol ; 31(5): 2994-3001, 2021 May.
Artículo en Inglés | MEDLINE | ID: mdl-33151392

RESUMEN

OBJECTIVES: To obtain information from radiology departments throughout Europe regarding the practice of emergency radiology METHODS: A survey which comprised of 24 questions was developed and made available online. The questionnaire was sent to 1097 chairs of radiology departments throughout Europe using the ESR database. All data were collected and analyzed using IBM SPSS Statistics software, version 20 (IBM). RESULTS: A total of 1097 radiologists were asked to participate, 109 responded to our survey. The response rate was 10%. From our survey, 71.6% of the hospitals had more than 500 beds. Ninety-eight percent of hospitals have an active teaching affiliation. In large trauma centers, emergency radiology was considered a dedicated section. Fifty-three percent of institutions have dedicated emergency radiology sections. Less than 30% had all imaging modalities available. Seventy-nine percent of institutions have 24/7 coverage by staff radiologists. Emergency radiologists interpret cross-sectional body imaging, US scans, and basic CT/MRI neuroimaging in more than 50% of responding institutions. Cardiac imaging examinations/procedures are usually performed by cardiologist in 53% of institutions, while non-cardiac vascular procedures are largely performed and interpreted by interventional radiologists. Most people consider the European Diploma in Emergency Radiology an essential tool to advance the education and the dissemination of information within the specialty of emergency radiology. CONCLUSION: Emergency radiologists have an active role in the emergency medical team. Indeed, based upon our survey, they have to interact with emergency physicians and surgeons in the management of critically ill patients. A broad skillset from ultrasonography and basic neuroimaging is required. KEY POINTS: • At most major trauma centers in Europe, emergency imaging is currently performed by all radiologists in specific units who are designated in the emergency department. • Radiologists in the emergency section at present have a broad skillset, which includes cross-sectional body imaging, ultrasonography, and basic neuroimaging of the brain and spine. • A dedicated curriculum that certifies a subspecialty in emergency radiology with a diploma offered by the European Society of Emergency Radiology demonstrates a great interest by the vast majority of the respondents.


Asunto(s)
Servicio de Urgencia en Hospital , Radiología , Estudios Transversales , Europa (Continente) , Humanos , Encuestas y Cuestionarios , Recursos Humanos
10.
J Stroke Cerebrovasc Dis ; 30(1): 105448, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-33166767

RESUMEN

OBJECTIVES: The enforcement of complete lockdown with home confinement has been necessary to limit SARS-CoV-2 contagions in Italy, one the most affected countries worldwide. Simultaneously, in several Emergency Departments, a reduction in cardio- and cerebrovascular presentations was noticed. This study analyses the impact of Covid-19 pandemic and lockdown measures on the incidence of stroke, in Campania, the most densely-populated region in Italy. MATERIALS AND METHODS: We retrospectively analyzed data regarding acute stroke patients presenting at 5 Campania stroke hubs, before and after the issue of lockdown in Italy on March 9th, 2020. RESULTS: Compared to the pre-lockdown, we observed a significant reduction in the number of acute reperfusion treatments in stroke (P for interact 0.001); however the global number of patients presenting with acute stroke did not significantly differ. The time to reach medical attention was significantly longer in the lockdown phase (230 versus 154 min, P 0.016). For patients who underwent acute reperfusion treatment we also observed significantly longer time-to-imaging (30 versus 40 min, P 0.0005) and a trend to longer time-to-needle (75 versus 90 min P 0.23), but not time-to-groin. CONCLUSIONS: This study showed the reduction in acute reperfusion treatments for acute ischemic stroke and the slowdown of stroke pathways, during the lockdown phase of Covid-19 pandemic, in Campania, the third-most-populous and the most-densely populated Italian Region. In the next future, the risk for high-grade disability and death, due to delayed or even avoided hospital presentation due to fear of contagion, may be high.


Asunto(s)
COVID-19/prevención & control , Admisión del Paciente/tendencias , Accidente Cerebrovascular/terapia , Trombectomía/tendencias , Terapia Trombolítica/tendencias , Anciano , Anciano de 80 o más Años , COVID-19/epidemiología , COVID-19/transmisión , Femenino , Humanos , Incidencia , Italia/epidemiología , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Accidente Cerebrovascular/diagnóstico , Accidente Cerebrovascular/epidemiología , Factores de Tiempo , Tiempo de Tratamiento/tendencias
12.
Neuroradiology ; 62(12): 1607-1615, 2020 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-32803337

RESUMEN

This article is to review the different types of vertebral augmentation implants recently becoming available for the treatment of benign and malignant spinal compression fractures. After a detailed description of the augmentation implants, we review the available clinical data. We will conclude with a summary of the advantages and disadvantages of vertebral implants and how they can affect the future treatment options of compression fractures.


Asunto(s)
Fracturas por Compresión/cirugía , Prótesis e Implantes , Fracturas de la Columna Vertebral/cirugía , Vertebroplastia/instrumentación , Fenómenos Biomecánicos , Fracturas por Compresión/diagnóstico por imagen , Humanos , Fracturas de la Columna Vertebral/diagnóstico por imagen
13.
World Neurosurg ; 142: 167-170, 2020 10.
Artículo en Inglés | MEDLINE | ID: mdl-32615295

RESUMEN

BACKGROUND: Intracranial vascular malformations are increasingly being treated via the endovascular route. Though generally safe, a multitude of intraprocedural complications that potentially lead to disastrous clinical outcomes may arise. It is crucial for the operators to be well versed with the various techniques that are available to overcome any procedure-specific complications. METHODS: We present 2 cases in which we encountered premature intravascular detachment of the microcatheter tip and coil migration while treating a dural arteriovenous fistula and aneurysm, respectively. We used a stentriever to remove the detached microcatheter tip and suction using the reperfusion catheter to remove the migrated coil, both techniques that have not been reported in the literature thus far. RESULTS: Detached microcatheter tip and migrated coil were successfully retrieved using a stentriever and aspiration catheter. CONCLUSIONS: These novel techniques could potentially reduce mortality and morbidity associated with neurointervention.


Asunto(s)
Fístula Arteriovenosa/cirugía , Catéteres/efectos adversos , Procedimientos Endovasculares/efectos adversos , Migración de Cuerpo Extraño/cirugía , Aneurisma Intracraneal/cirugía , Malformaciones Arteriovenosas Intracraneales/cirugía , Neuronavegación/métodos , Anciano , Fístula Arteriovenosa/diagnóstico por imagen , Embolización Terapéutica/efectos adversos , Embolización Terapéutica/métodos , Procedimientos Endovasculares/métodos , Migración de Cuerpo Extraño/diagnóstico por imagen , Humanos , Aneurisma Intracraneal/diagnóstico por imagen , Malformaciones Arteriovenosas Intracraneales/diagnóstico por imagen , Masculino , Persona de Mediana Edad
14.
Neuroradiology ; 62(8): 905-923, 2020 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-32313979

RESUMEN

PURPOSE: Multiple myeloma is a type of blood cancer arising from the uncontrolled clonal proliferation of malignant plasma cells resulting in impaired hematopoiesis, hyper production of monoclonal protein, bone tissue destruction leading and renal system alterations up to kidney failure. The aim is to review the state-of-the-art of radiological imaging in multiple myeloma. METHODS: Radiological techniques as well as the advancements in imaging technology have been reviewed and summarized. The main radiological findings of different imaging techniques in patients suffering from multiple myeloma are also illustrated. RESULTS: Different radiological techniques provide structural and functional data. In the last years, conventional skeletal survey has gradually lost its utility and it has been replaced by whole body low-dose computed tomography which allows to identify also small lytic lesions, the medullary and the extramedullary involvement. Nowadays, magnetic resonance is the most sensitive imaging technique for detecting of skeletal as well as medullary involvement in patients with multiple myeloma. Thanks to the multiparametric evaluation (morphological, diffusion weighted and perfusion imaging sequences) and to the quantitative analysis, magnetic resonance imaging is proved to be useful in the early evaluation of response to therapy. Finally, positron emission tomography has greater sensibility compared to computed tomography as it provides quantitative data; however, the lower expression levels of the specific gene involved in the glycolysis pathway are associated with false-negative results with consequent underestimation of the disease. CONCLUSION: The only use of the advanced combined multimodal imaging allows a better evaluation, staging and early assessment of treatment response in patients with multiple myeloma.


Asunto(s)
Imagen Multimodal , Mieloma Múltiple/diagnóstico por imagen , Neuroimagen , Humanos , Imagen de Cuerpo Entero
15.
Eur J Radiol ; 127: 108960, 2020 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-32298957

RESUMEN

The craniocervical junction (CCJ) or upper cervical spine (UCS) has anatomic features and a biomechanics completely different from the other spinal segment of the spine. Several ligaments and muscles control its motion and function and ensure the maximum mobility and the visual and auditory spatial exploration. UCS traumas represent approximately one-third of all cervical spine injuries. Most of UCS traumas results from blows to the head and sudden deceleration of the body. Thanks to the improvement of the Advanced Trauma Life Support protocols dissociative injuries of CCJ have become less lethal onsite. In other less severe but unstable injuries, patients are neurologically intact at presentation, but they may deteriorate during the stay in hospital, with important clinical and medico-legal consequences. Knowing the peculiarities of UCS is fundamental for the early detection of imaging findings that influences the patient management and outcome. The classification of UCS traumas is mechanistic. More than in any other spinal segment, fractures of CCJ bones can occur without generating instability; on the contrary highly unstable injuries may not be associated with bone fractures. An early and correct diagnosis of occipito-cervical instability may prevent secondary neurological injury. The goal of imaging is to identify which patients can benefit of surgical stabilization and prevent secondary neurologic damage. Actual helical multidetector-CT (MDCT) offers high sensitivity and specificity for bone lesions and displacements in cervical spine traumas, but magnetic resonance imaging (MRI) is increasingly being used to evaluate soft tissues and ligaments, and mainly to identify possible spinal cord injury.


Asunto(s)
Vértebras Cervicales/diagnóstico por imagen , Vértebras Cervicales/lesiones , Diagnóstico por Imagen/métodos , Traumatismos Vertebrales/diagnóstico por imagen , Lesiones por Latigazo Cervical/diagnóstico por imagen , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Adulto Joven
16.
MAGMA ; 33(4): 549-557, 2020 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-31782035

RESUMEN

OBJECTIVES: Synthetic magnetic resonance imaging (SyMRI) allows to obtain different weighted-images using the multiple-dynamic multiple-echo sequence lasting 6 min. The aim is to compare quantitatively and qualitatively synthetic- and conventional MRI in patients with multiple sclerosis (MS) and controls assessing the contrast (C), the signal to noise ratio (SNR), and the contrast to noise ratio (CNR). We evaluated the lesion count and lesion-to-white matter contrast ([Formula: see text] in the MS patients. METHODS AND METHODS: 51 patients underwent synthetic- and conventional MRI. Qualitative analysis was evaluated by assigning scores to all synthetic- and conventional MRI sequences by two neuroradiologists. Lesions were counted in MS patients both in the conventional- and synthetic T2-FLAIR. Regions of interest were placed in the cerebrospinal fluid, in the white- and grey matter. For the sequences were evaluated: C, CNR, and SNR. RESULTS: Synthetic T2-FLAIR images are qualitatively inferior. C and CNR were significantly higher in synthetic T1W and T2W images compared to conventional images, but not for T2-FLAIR. The SNR value was always lower in synthetic images than in conventional ones. CONCLUSIONS: SyMRI can be used in clinical practice because it has a similar diagnostic accuracy which reduces the scanning time compared to the conventional one. However, synthetic T2-FLAIR images need to be improved.


Asunto(s)
Encéfalo/diagnóstico por imagen , Imagen por Resonancia Magnética/métodos , Esclerosis Múltiple/diagnóstico por imagen , Relación Señal-Ruido , Adulto , Anciano , Anciano de 80 o más Años , Medios de Contraste , Femenino , Humanos , Aumento de la Imagen/métodos , Procesamiento de Imagen Asistido por Computador , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Sustancia Blanca/diagnóstico por imagen , Adulto Joven
17.
Radiol Med ; 125(3): 319-328, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-31863360

RESUMEN

Hypophysitis (HP) is a rare acute or chronic inflammatory condition of the pituitary gland. The greatest challenge in the management of HP is establishing a diagnosis through clinical criteria and non-invasive methods and predicting the patients' clinical outcome. The aim of this review is to describe the neuroradiological findings of this rare disease, providing some information regarding the possible differential diagnosis in order to avoid unnecessary surgery. Gadolinium-enhanced pituitary magnetic resonance imaging (MRI) is considered the neuroradiological investigation of choice. The features suggestive for HP include an enlarged triangular- or dumbbell-shaped gland with a thickened and not obviously deviated stalk, further supported by the absence of posterior pituitary bright spot on T1weighted images, particularly in patients presenting with diabetes insipidus. Contrast enhancement pattern is quite variable; dural enhancement has been reported in some cases after intravenous contrast administration. The characterization of the unusual sellar mass is not straightforward and generally results in a wide differential. HP should be primarily differentiated from pituitary adenomas (including pituitary apoplexy), from pituitary metastases, and from other sellar and parasellar tumors, e.g., craniopharyngiomas, germinomas, gliomas, lymphomas, meningiomas, pituicytomas, chordomas, teratomas, dermoids and epidermoids, Rathke's cleft cysts, and abscesses. In patients suspected for secondary forms related to systemic pathology, additional imaging is helpful in identifying other involved sites. Neuroradiologists need to know MRI appearance of this rare disease, as well as its typical symptoms and serological markers. A strict collaboration with endocrinologists and neurosurgeons is mandatory in order to reach a definitive diagnosis, allowing to promptly initiating an appropriate treatment.


Asunto(s)
Hipofisitis/diagnóstico por imagen , Imagen por Resonancia Magnética , Neurorradiografía , Hipófisis/diagnóstico por imagen , Adenoma/diagnóstico por imagen , Hipofisitis Autoinmune/diagnóstico por imagen , Medios de Contraste , Diagnóstico Diferencial , Gadolinio , Humanos , Enfermedad Relacionada con Inmunoglobulina G4/diagnóstico por imagen , Neoplasias Hipofisarias/diagnóstico por imagen , Xantomatosis/diagnóstico por imagen
18.
Neurosurgery ; 86(Suppl 1): S85-S94, 2020 01 01.
Artículo en Inglés | MEDLINE | ID: mdl-31838532

RESUMEN

Flow diverter devices have gained wide acceptance for the treatment of unruptured intracranial aneurysms. Most studies are based on the treatment of large aneurysms harboring on the carotid syphon. However, during the last years the "off-label" use of these stents has widely grown up even if not supported by randomized studies. This review examines the relevant literature concerning "off-label" indications for flow diverter devices, such as for distal aneurysms, bifurcation aneurysms, small aneurysms, recurrent aneurysms, and direct carotid cavernous fistulas.


Asunto(s)
Embolización Terapéutica/instrumentación , Procedimientos Endovasculares/instrumentación , Aneurisma Intracraneal/terapia , Selección de Paciente , Embolización Terapéutica/métodos , Procedimientos Endovasculares/métodos , Humanos , Resultado del Tratamiento
20.
Neuroradiology ; 62(1): 7-14, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31676960

RESUMEN

This document sets out standards for training in Interventional Neuroradiology (INR) in Europe. These standards have been developed by a working group of the European Society of Neuroradiology (ESNR) and the European Society of Minimally Invasive Neurological Therapy (ESMINT) on the initiative and under the umbrella of the Division of Neuroradiology/Section of Radiology of the European Union of Medical Specialists (UEMS).


Asunto(s)
Neurorradiografía/normas , Radiología Intervencionista/educación , Radiología Intervencionista/normas , Certificación/normas , Europa (Continente) , Humanos
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