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To evaluate the pathological changes of the lumbar spine and the instability of the lumbar intervertebral joints observed in patients with low back pain, with the study of the transition from supine to orthostatic position through the use of dedicated MRI-G-scan machine. Within 10 years, 4305 patients, aged between 21 and 80 years old, with history of low back pain with or without sciatica, underwent MRI examinations in upright and in supine position. The open MRI-scanner used is Esaote G-scan, which enables the acquisition of images in supine and standing positions. The used sequences were sagittal T2-weighted FSE, T1-weighted SE and axial 3D HYCE. Patients were divided into two groups: “negatives”, with no changes in the two positions (supine and upright), and “positives”, with MRI modifications of imaging in upright position. Orthostatic examination showed MRI changes in 2870 out of 4305 (66.6 %) patients, including 1252 males and 1618 females. The G-scan is useful to assess instability of the lumbar spine detecting hidden modifications of protrusions and/or herniated discs already present in the supine position. It is also helpful in assessing the presence or modification of spondylolisthesis and lumbar canal stenosis.

The extreme variability of clinical and MRI findings in the suspicion of Devic's disease always requires the detection of specific antibodies (AQP4). MRI scans were performed with a high-field MRI scanner (1.5T General Electric Signa Horizon): the MRI protocol of the brain employed axial DP, T2, T1, FLAIR and DWI weighted images (wi) and coronal T2-wi. After intravenous administration of contrast medium axial and sagittal T1-weighted images of the brain were repeated. The spine protocol employed after contrast medium included sagittal T2-wi, T2-wi with fat suppression and T1-wi. In May 2004, a 64-year-old healthy Caucasian woman began to suffer loss of motor and thermal sensitivity in the left lower limb. MRI showed nonspecific areas of abnormal signal intensity on the deep left frontal and right frontoparietal white matter with no pathological enhancement after contrast medium and a small intramedullary area of altered signal at metameric level C2–C4 with a diagnosis of post-viral transverse myelitis. The patient had two similar episodes years later so the neurologist decided to search for circulating IgG AQP4 with the definitive diagnosis of neuromyelitis optica. In this case, compared to a clinical presentation of atypical deficit neurological involvement, the neuroradiological results of a progressive diffuse involvement of the white matter were atypical.

Patients with post-traumatic stress disorder (PTSD) exhibit exaggerated brain responses to emotionally negative stimuli. Identifying the neural correlates of emotion regulation in these subjects is important for elucidating the neural circuitry involved in emotional dysfunction. The aim of this study was to investigate the functional connectivity between the areas activated during emotional processing of negative stimuli in a sample of individuals affected by PTSD compared to a group of healthy subjects. Ten subjects with PTSD (who survived the L’Aquila 2009 earthquake) and ten healthy controls underwent fMRI during which the participants observed 80 images: 40 pictures with negative emotional valence and 40 neutral (scrambled) stimuli. A higher activation was found in the left posterior (LP) insula for PTSD group and in the ventromedial prefrontal cortex (vmPFC) for the healthy group. Two sets of Granger causality modeling analyses were performed to examine the directed influence from LP-insula and vmPFC to other brain regions. Activity in the vmPFC in the healthy group while observing negative stimuli predicted activity in several subcortical regions and insula, while in the PTSD group the LP-insula exerted a positive directed influence on several cortical regions. The hyperactivation in PTSD subjects of subcortical areas such as the insula would underlie the emotional, social, and relational difficulties of PTSD patients.

The "default mode", or baseline of brain function is a topic of great interest in schizophrenia research. Recent neuroimaging studies report that the symptoms of chronic schizophrenia subjects are associated with temporal frequency alterations as well as with the disruption of local spatial patterns in the default mode network (DMN). Previous studies both on chronic and medicated subjects with psychosis suffered from limitations; on this basis, it was hypothesized that the default mode network showed abnormal activation and connectivity in young and neuroleptic-naïve patients with first-episode psychosis. This study investigated emotional responses to pleasant and unpleasant/disgusting visual stimuli by a resting-state analysis of fMRI-data from 12 untreated first-episode psychosis patients with prevalently negative symptomatology versus 12 healthy subjects. We chose this experimental task to explore the functional link between default mode network and hedonic processing which has been proposed as a marker of cerebral dysfunction in psychotic disorder and implicated in its pathophysiology. Independent Component Analysis (ICA) was used to identify the default mode component. Both healthy and first-episode subjects showed significant spatial differences in the default mode network. In first-episode subjects, medial frontal hypoactivity and cerebellar hyperactivity were correlated with the severity of negative symptoms.

To determine whether Radiofrequency Ablation (RFA) followed by Radiotherapy (RT) (RFA-RT) produces better palliation in terms of pain than RT alone in patients with osteolytic bone metastases. Patients with solitary bone metastases and a pain score of least 5 or more on the VAS scale were selected. Fifteen patients were treated with RFA-RT (20 Gy delivered in 5 fractions of 4 Gy over 1 week) and were compared with a matched group (30 subjects) treated by RT. A complete response in terms of pain relief at 12 weeks was documented in 16.6% (5/30) and 53.3% (8/15) of the subjects treated by RT or RFA-RT, respectively (p = 0.027). The overall response rate at 12 weeks was 93.3% (14 patients) in the group treated by RFA-RT and 59.9% (18 patients) in the group treated by RT (p = 0.048). Although recurrent pain was documented more frequently after RT (26.6%) than after RFA-RT (6.7%) the difference did not reach statistical significance. The morbidity related to RT did not significantly differ when this treatment was associated with RFA. Our results suggest that RFA-RT is safe and more effective than RT. The findings described here should serve as a framework around which to design future clinical trials.

OBJECTIVE: Our aim was to review the emergent neuroimaging findings of alcohol-related CNS nontraumatic disorders. Alcohol (ethanol) promotes inflammatory processes, increases DNA damage, and creates oxidative stress. In addition, the accompanying thiamine deficiency may lead to Wernicke encephalopathy. Associated changes in serum osmolarity may lead to acute demyelination. CONCLUSION: Alcohol-related encephalopathies can be life-threatening conditions but can be prevented or treated, if recognized.

The European Course of Neuroradiology (ECNR) was set up in 1983 under the aegis of the European Society of Neuroradiology (ESNR) founded in 1969. Besides the major aim of educating young doctors to become neuroradiologists, this course was also necessary to adhere as much as possible to the European regulations for academic education programs with the precise aim of being recognized as a sub-speciality within the European Union of Medical Specialists (UEMS). It was meant to be a dynamic initiative flanking the existing European Course of Neurosurgery (ECNS) thereby creating a true European neuroradiological profile. During the past years, our speciality has undergone many changes, the most obvious of which being that neuroradiology is nowadays widely accepted as both a diagnostic and interventional speciality. Guidelines for training and practice were established and specifically targeted the above-mentioned dual aspects of neuroradiology. Since March 2008 our goal of becoming a subsection within the UEMS has been rea-ched, further stressing the need to provide a European Course of Neuroradiology that adheres more obviously to our training guidelines which are both diagnostic and interventional. Under the directorate of Prof. Radu from Basel who organized the 8th and 9th cycles of the ECNR with huge success in Basel during the past four years, the first steps towards the dual aspect of the ECNR had been undertaken. With the 10th cycle we plan to continue on this path and even further stress our “interventional” educational mission with the ECNR being the course of the European Society for both diagnostic and interventional neuroradiology. The scientific content of the 10th Cycle will provide unique material and will take into very close account the standards and guidelines for residency training in clinical neuroradiology (diagnostic and interventional) included in the European Charter on Training of Medical Specialists in the European Union (EU), a document needed by the European Commission with the principal aim of standardizing training programs in the countries of the EU and associated member states. Different from the usual “refresher courses”, the 10th Cycle is mainly directed toward in-training or established neuroradiologists and has the following main scientific objectives and characteristics: 1) Impart teaching-based lectures and workshops, rather than academic-type conferences in order to transmit rather than deliver information. 2) Provide the students with scientific and conceptual lectures, which they are unlikely to obtain in their own countries, or from general radiology courses or textbooks. 3). Acquire basic neuroscience and clinical core knowledge. 4) Provide theoretical bases of present and future clinical practices and research in diagnostic and interventional neuroradiology. 5) Impart highly interactive diagnostic, interventional and mixed-type neuroradiological workshops. The interventional topics are chosen in close collaboration with the World Federation of Interventional and Therapeutic Neuroradiology (WFITN) to assure the highest academic standards and to adhere to the Training Path of Interventional Neuroradiology consisting basic and theoretical knowledge, practical experience, and skill training. All topics are discussed by the board of the European Course of Neuroradiology comprising the course directors, the EBNR and ten established diagnostic and interventional neuroradiologists from Europe. Because of the broad coverage of interventional and diagnostic neuroradiology, the 10th cycle has also been approved by the European Society of Radiology (ESR) as being a modular part of the European School of Radiology (ESOR), further emphasizing its role as the European Course of Neuroradiology. The following topics have been chosen for each of the four courses to be covered in six full days of lectures and workshops: 1) Embryology/Anatomy/Malformations/Genetics (Tarragona, Spain October, 2008). 2) Tumours (Rome, Italy March, 2009). 3) Vascular Diseases (Tarragona, Spain October, 2009). 4) Trauma/Degenerative/Me-tabolic/ Inflammatory Diseases (Rome, Italy March 2010). The didactic credits provided for the course are intended to comply with the regulations of academic education programs. The cycles are structured in four modules held over two years. At the end of each module a certificate reporting CME credits is issued after completing a written test. Upon completion of all four modules (one entire cycle) participants can apply to take a final oral examination. If they pass, a certification as a qualified neuroradiologist (European Qualification in Neuroradiology EQNR) will be issued jointly by ESNR and EBNR. This EQNR is part of the European Qualification, as required by the UEMS for Specialities. We hope that with the 10th cycle we will be able to step into the large footsteps of the past courses and add our own marks to the education of future neuroradiologists. We look forward to meeting you in Tarragona and in Rome.

An MRI-pathological correlation was obtained in 15 disc herniations from 15 patients undergoing surgery. The study showed that when peridiscal enhancement was evident on MRI, granulation tissue with macrophagic cells was present histopathologically. Disc fragment infiltration by this tissue appeared as diffuse enhancement of the disc itself on MRI. High signal on T2-weighted images was related to hyperhydration of the fragment. These data indicate that high signal on T2-weighting and peridiscal enhancement are features typical of the first phases of disc herniation.

Follow-up magnetic resonance (MR) studies of a child affected by Hallervorden-Spatz disease were performed over a period of 3 years. The hyperintense pallidi shown in the first examination changed to a mixed intensity target-like appearance. All the patterns observed in our patient have been described in the literature but in different subjects. Our data show these findings to be different manifestations of the same disease during its evolution.

NMR has proved useful in the detection of Acute Cerebrovascular Disorders (ACVD), providing information related either to the tissue signal intensity and relaxation times, or to the morphological aspects of cerebral structures. Eighteen patients suffering from ischemic Acute Cerebrovascular Disorders were studied. A comparison between NMR imaging and CT scan was performed. Ischemic lesions, presence of edema, presence of reactive gliosis and anatomical vascular anomalies were found.