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Brain arteriovenous malformations (bAVMs) are congenital defects of vasculogenesis, the natural history of which is characterized by a significant morbidity and mortality related to the risk of bleeding. Their management remains challenging, since complete eradication is often difficult. Embolization, surgery, or radiosurgery alone are safe and effective for small unruptured AVMs, while a multidisciplinary approach should be pursued for larger ones. We report a case of intracerebral haemorrhage due to the rupture of a large bAVM, for which a multidisciplinary approach was adopted: endovascular partial embolization followed by complete surgical removal.

A 40-year-old man with no history of trauma or previous sinus surgery complained sudden right diplopia after vigorous sneezing. The patient was submitted elsewhere to a MRI study for persisting diplopia, with inconclusive findings. One week later the patient was submitted to a maxillofacial cone beam CT (CBCT) in our Institution. A blowout fracture of the right orbital floor and lateral orbital wall with an intact orbital rim and a ipsilateral maxillary sinus effusion with an air liquid level, were detected at the CBCT study. Our conclusion, confirmed by the clinician, was the patient had a barotraumatic, isolated, pure blowout fracture of the right orbit consequence of the episode of vigorous sneezing. The patient was treated by steroid and antibiotic therapy and diplopia resolved after two weeks. Clinicians and radiologists should be aware that a barotraumatic blowout fracture of the orbit after sneezing should be included among the unusual causes of sudden diplopia.

Scopo Il coinvolgimento delle ghiandole lacrimali (GL) in pazienti affetti da Oftalmopatia di Graves (OG) è stato considerato come una potenziale causa dei sintomi tipicamente associati a questa malattia. Diversi studi hanno rilevato che le dimensioni delle GL nei pazienti OG sono aumentate, ma non ci sono studi che prendono in considerazione pazienti con diversa attività della malattia. Abbiamo valutato l'erniazione delle GL rilevata sulle immagini di risonanza magnetica (RM), in pazienti con diversa attività OG. Materiale e metodi Trentadue pazienti (10M, 22F, età media 49,5 anni, range 30-68) con OG sono stati arruolati e raggruppati in base all'attività della malattia (A: n = 16 con OG inattivo, Clinical Activity Score (CAS)

This paper presents the development of a novel architecture for the low voltage (LV) electrical distribution on board using a mixed AC/DC approach. The design of the proposed solution is based on a real-world case study, i.e., an electrical distribution grid within a main vertical zone (MVZ) of a large cruise ship. The new electrical architecture is designed with the aim of obtaining a gradual transition toward a totally DC electrical distribution grid on-board. Furthermore, according to the selected technical criteria, the proposed scheme can be implemented on a real ship by using devices either available in the market or easily adaptable from commercial items. The impact of the proposed electrical design on technical volumes and weights of the electrical equipment is evaluated in comparison with the existing solution. Such a comparison shows that the proposed scheme allows a reduction of electrical plant components' weight and volume of about 30%.

Burnout syndrome is a condition that may occur not only for staff in human service sectors/jobs, involving intensive interactions with others, but also people that are engaged in activities psychologically similar to work, such as students. Radiographers in training suffer double stress, first linked to the status of being a university student and secondly as early career workers who have relations with the public of the health system. Aim of our study was to investigate the prevalence and levels of burnout syndrome among radiographers in training in an University Hospital.In order to gain a better understanding of nature of the burnout syndrome a modified version of Maslach's questionnaire (investigating three areas: emotional exhaustion, depersonalization and reduced personal accomplishment), was administered to two groups selected from a cohort of radiographers University students (from the 1st and 3rd year of course).62/62 questionnaires were completed, returned and analysed. The research outcomes highlighted a clear difference between group I and group II in relation to one of the three areas of the Maslach's model: "depersonalization" (p0.001). Moreover, the third year students group presented a significantly higher risk to develop burnout. On the other hand, the third area examined, the reduced personal accomplishment domain, was surprisingly high even among first-year students.The research outcomes seem to suggest that the presence of emotional burnout, or risk of burnout, among third year students is statistically significant, compared to the first year students, being a significant aspect to investigate further in this class of students. It is also assumed that the high degree of "past failures, feeling of self failure" observed among all student, is related to a feeling of poor efficacy and poor self worth that appear to grow from the beginning of the course. This topic needs further investigation in the light of the result of this study.Scopo. Il burnout è una sindrome che può interessare operatori e professionisti che sono impegnati quotidianamente e ripetutamente in attività che implicano le relazioni interpersonali, lavorando a stretto contatto con il pubblico, ma anche persone impegnate in attività psicologicamente simili al lavoro, come gli studenti. Gli studenti di tecniche di radiologia sono sottoposti ad un doppio stress, sia a quello legato allo stato di studente, che a quello legato allo stato di lavoratore a contatto con il pubblico durante il loro periodo di tirocinio professionale. Scopo del nostro studio è stato quello di investigare la prevalenza della sindrome da burnout tra i tecnici di radiologia in formazione in un Ospedale Universitario. Metodi. Per ottenere una migliore comprensione della natura della sindrome da burnout è stato somministrata una versione modificata del questionario di Maslach (che investiga 3 aree: esaurimento emotivo, depersonalizzazione e ridotta realizzazione personale) a 2 sottogruppi selezionati da una coorte di studenti Universitari in tecniche di radiologia (del 1° e 3° anno di corso). Risultati. Sono stati completati, consegnati ed analizzati 62/62 questionari. I risultati della ricerca hanno evidenziato una chiara differenza tra i 2 gruppi in una delle tre aree del modello di Maslach: la “depersonalizzazione”. Inoltre, la terza area esaminata, la ridotta realizzazione personale, è risultata sorprendentemente elevata anche tra gli studenti di primo anno. Conclusioni. I risultati della ricerca suggeriscono che la presenza di burnout emozionale, o il rischio di burnout, tra gli studenti del terzo anno sia statisticamente significativa se confrontata con i risultati degli studenti del primo anno di corso, rendendolo un aspetto da investigare più a fondo in questa classe di studenti. Si suppone che l’alto livello di senso di fallimento personale osservato tra gli studenti, sia correlato con un sentimento di scarsa autostima che sembra crescere dall’inizio del corso.

Aims and objectives Methods and materials Results Conclusion Personal information References, Aims and objectives: Adverse reactions to intravenous contrast media (CM) agents are uncommon, although relevant due to the growing number of radiologic examinations that use iodinated contrast agents [1]. Reaction may be patient related and risks of acute adverse...

BACKGROUND AND OBJECTIVE Optical Coherence Tomography (OCT) enables rapid, non-invasive in vivo measurement of retinal nerve fiber layer (RNFL) thickness, reflecting axonal density within the optic nerve. There is still lack of concordance about the use of OCT in clinical routine as a surrogate measure of brain atrophy. Objective: To investigate the role of OCT as possible predictor of disability, cognitive impairment and neurodegeneration in Multiple Sclerosis (MS). MATERIAL AND METHODS We recruited patients affected by MS according to validated criteria at the Neurological Department of the University of Palermo. Patients performed Stratus OCT- 3 Zeiss to assess RNFL and GCS measurements. Nearly 18 months later, the same patients were re-evaluated. Clinical and cognitive status was assessed also using an extensive neuropsychological battery exploring attention, executive functions and working memory, verbal and visuo-spatial memory, visuospatial functions and language and BICAMS (Brief International Cognitive Assessment for Multiple Sclerosis). Patients performed all subtests of the Italian standardized version. Subjects underwent a single-time-point brain scan using a 1.5T MRI unit; an isotropic 3D-FSPGR T1w sequence was used for brain tissue volume estimation (normalized for subject head size) with tissue-type segmentation by the use of FSL’s package SIENAX. We collected information about disease status, EDSS, relapse rate and current and former therapies. RESULTS Thirty patients (20 women; 27 RR, 2 SP) were recruited for the study. Patients were divided into two groups considering if they were affected by a previous optic neuritis (ON yes) or not (ON no). Ten patients performed the MRI scan. Twenty-two patients were on therapy (5 Interferon beta 1 a, 8 Natalizumab, 8 Fingolimod and 1 azathioprine) and 8 patients don’t take any specific therapy.DISCUSSION AND CONCLUSION.The present study confirms previous data indicating an association between a previous optic neuritis and RFNL thickening. We didn’t observe a significant association with cognitive performances. We observed a significant association also between RFNL thickness and grey matter atrophy independent by neuropsychological performances .There is a need to increase the sample of the study and for longitudinal studies to further clarify the role of OCT as a surrogate marker of degeneration.

Aims and objectives Methods and materials Results Conclusion Personal information References, Aims and objectives: -To create a MR radiological template for endometriosis -To review MR reports and images in patients with endometriosis to assess the accurancy of the...

Many reports have described adrenal myelolipomas but there have been only a few reports of extra-adrenal myelolipomas. We describe a 74-year-old woman who came to our observa- tion for MRI of the lumbar spine for typical lumbar back pain. In addition to signs of mild scoliosis and spondylo disc arthrosis, MR imaging revealed a presacral mass showing a heterogeneously high signal in all pulse sequences and almost completely suppressed on inversion recovery sequences for fat tissue. CT imaging confirmed the fatty nature of the lesion and no signs of bone involvement. These findings were most consistent with a diagnosis of a rare presacral myelolipoma as confirmed at histopathologic analysis. This work reports a case of one of the rarest presacral masses, empha- sizing the role of imaging in the differential diagnosis of other presacral masses.

The CT-v can therefore be considered an effective method as an aid in the autopsy evaluation of individuals who died for various causes; in particular, in the case of deaths due to accidental falls from high altitudes, is able to identify the primary cause of death and all the epiphenomena due to precipitation.

PURPOSE: This study was done to evaluate the psychological state and anxiety of patients undergoing computed tomography coronary angiography (CTCA), and assess their acceptance and satisfaction compared to invasive conventional coronary angiography (CCA). MATERIALS AND METHODS: A total of 442 consecutive patients (282 male; mean age 57.7 ± 9.5 years) who underwent CTCA for suspected or known coronary artery disease were evaluated with the Endler Multimodality Anxiety Scales (EMAS) before and after the scan, and a questionnaire administered after the scan. Among the 442 patients, 181 had a history of CCA. Two radiologists assessed the image quality of CTCA. RESULTS: Anxiety was more intense prior to the scan (EMAS score 51.7 vs. 46.7, p < 0.01) and in patients with a history of CCA (EMAS score 55.5 vs. 49.1, p < 0.01). Women presented more intense anxiety (EMAS score 59.5 vs. 47.3, p < 0.01), higher mean heart rate (63.5 ± 7.6 vs. 60.7 ± 7.3 beats per minute, p < 0.01) and a lower image quality than men (p < 0.0001). CTCA proved to be more acceptable than CCA because of accurate preparation, lower concern prior to the examination, negligible pain, higher comfort, and greater overall satisfaction (p < 0.0001). CONCLUSIONS: Computed tomography coronary angiography is a patient-friendly imaging method because of the minimal perceived discomfort. Anxiety may affect CTCA image quality in women.

The integration of an electrical storage system (ESS) into a DC microgrid using a bidirectional DC/DC converter provides substantial benefits but requires careful design. Among such converter topologies, the Split-pi converter presents several merits at the cost of non-isolated operation. However, the few works in the literature on the Split-pi presented only closed-loop control with a single control loop; furthermore, they neglected the reactive components’ parasitic resistances and did not perform any experimental validation. This work aimed at investigating the use of the Split-pi converter as a power interface between an ESS and a DC microgrid. Five typical microgrid scenarios are presented, where each of which requires a specific state-space model and a suitable control scheme for the converter to obtain high performance. In this study, two different state-space models of the converter that consider the parasitic elements are presented, the control schemes are discussed, and criteria for designing the controllers are also given. Several simulations, as well as experimental tests on a prototype realized in the lab, were performed to validate the study. Both the simulation and experimental results will be presented in part II of this work. The proposed approach has general validity and can also be followed when other bidirectional DC/DC converter topologies are employed to interface an ESS with a DC microgrid.

Parkinson’s disease (PD) is a progressive neurodegenerative disorder, characterized by motor and non-motor symptoms due to the degeneration of the pars compacta of the substantia nigra (SNc) with dopaminergic denervation of the striatum. Although the diagnosis of PD is principally based on a clinical assessment, great efforts have been expended over the past two decades to evaluate reliable biomarkers for PD. Among these biomarkers, magnetic resonance imaging (MRI)-based biomarkers may play a key role. Conventional MRI sequences are considered by many in the field to have low sensitivity, while advanced pulse sequences and ultra-high-field MRI techniques have brought many advantages, particularly regarding the study of brainstem and subcortical structures. Nowadays, nigrosome imaging, neuromelanine-sensitive sequences, iron-sensitive sequences, and advanced diffusion weighted imaging techniques afford new insights to the non-invasive study of the SNc. The use of these imaging methods, alone or in combination, may also help to discriminate PD patients from control patients, in addition to discriminating atypical parkinsonian syndromes (PS). A total of 92 articles were identified from an extensive review of the literature on PubMed in order to ascertain the-state-of-the-art of MRI techniques, as applied to the study of SNc in PD patients, as well as their potential future applications as imaging biomarkers of disease. Whilst none of these MRI-imaging biomarkers could be successfully validated for routine clinical practice, in achieving high levels of accuracy and reproducibility in the diagnosis of PD, a multimodal MRI-PD protocol may assist neuroradiologists and clinicians in the early and differential diagnosis of a wide spectrum of neurodegenerative disorders.

Purpose: Aim of this study was to evaluate a fully automated deep learning network named Efficient Neural Network (ENet) for segmentation of prostate gland with median lobe enlargement compared to manual segmentation. Materials and Methods: One-hundred-three patients with median lobe enlargement on prostate MRI were retrospectively included. Ellipsoid formula, manual segmentation and automatic segmentation were used for prostate volume estimation using T2 weighted MRI images. ENet was used for automatic segmentation; it is a deep learning network developed for fast inference and high accuracy in augmented reality and automotive scenarios. Student t-test was performed to compare prostate volumes obtained with ellipsoid formula, manual segmentation, and automated segmentation. To provide an evaluation of the similarity or difference to manual segmentation, sensitivity, positive predictive value (PPV), dice similarity coefficient (DSC), volume overlap error (VOE), and volumetric difference (VD) were calculated. Results: Differences between prostate volume obtained from ellipsoid formula versus manual segmentation and versus automatic segmentation were statistically significant (P < 0.049318 and P < 0.034305, respectively), while no statistical difference was found between volume obtained from manual versus automatic segmentation (P = 0.438045). The performance of ENet versus manual segmentations was good providing a sensitivity of 93.51%, a PPV of 87.93%, a DSC of 90.38%, a VOE of 17.32% and a VD of 6.85%. Conclusion: The presence of median lobe enlargement may lead to MRI volume overestimation when using the ellipsoid formula so that a segmentation method is recommended. ENet volume estimation showed great accuracy in evaluation of prostate volume similar to that of manual segmentation.

Gambling disorder (GD) is a psychiatric disease that has been recently classified as a behavioural addiction. So far, a very few studies have investigated the alteration of functional connectivity in GD patients, thus the concrete interplay between relevant function-dependent circuitries in such disease has not been comprehensively assessed. The aim of this research was to investigate resting-state functional connectivity in GD patients, searching for a correlation with GD symptoms severity. GD patients were assessed for gambling behaviour, impulsivity, cognitive distortions, anxiety and depression, in comparison with healthy controls (HC). Afterwards, they were assessed for resting-state functional magnetic resonance imaging; functional connectivity was assessed through a data-driven approach, by using independent component analysis. The correlation between gambling severity and the strength of specific resting-state networks was also investigated. Our results show that GD patients displayed higher emotional and behavioural impairment than HC, together with an increased resting state functional connectivity in the network including anterior cingulate cortex, the caudate nucleus and nucleus accumbens, and within the cerebellum, in comparison with the control group. Moreover, a significant correlation between behavioural parameters and the strength of the resting-state cerebellar network was found. Overall, the functional alterations in brain connectivity involving the cerebellum observed in this study underpin the emotional and behavioural impairment recorded in GD patients. This evidence suggests the employment of novel neuromodulatory therapeutic approaches involving specific and salient targets such as the cerebellum in addictive disorders.

Pituitary carcinomas (PCa) are extremely rare, indistinguishable from pituitary adenomas on histopathological grounds and have a poor prognosis. Most PCa start as PRL or ACTH secreting tumors in males, with relapsing invasive behaviour, refractoriness to medical and radiotherapy and increasing hormonal levels. The presence of distant metastases is still required for the diagnosis of PCa. The association with genetic endocrine diseases must be taken into account, since it adds further risk of evolution towards malignancy. Intradural spinal metastases have also been reported, so a complete craniospinal MR evaluation is recommended, when clinically indicated. We report a case of PCa, associated with MEN1 syndrome, with evidence of meningeal spread to the tentorium cerebelli, clival dura and spinal drop metastases mimicking spinal nerves schwannomas.

Listeria monocytogenes (LM) bacterium is a cause of central nervous system (CNS) infection and the most common cause of rhombencephalitis in immunocompetent elderly. A prompt identification of this condition should be always desirable, since its clinical manifestations are often unspecific with prodromal symptoms leading to high rates of morbidity and mortality if underestimated. CNS listeriosis magnetic resonance imaging (MRI) findings are generally not specific. However, in the appropriate clinical setting, focal brainstem hyperintensity on T2-weighted pulse sequences associated with ring-enhancement pattern after i.v. contrast media injection should be suspicious of LM abscess. The diagnosis cannot exempt from anamnestic-clinical-investigation data correlation to exclude mimicking. We report the case of a 72-year-old man with fever, headache, vomiting, and persistent hiccups with an increasing walking difficulty. A progressive worsening of the state of consciousness led him to a stupor state. Brain MRI examination detected multiple rhombencephalic abscesses. Among these, one was with atypical hemorrhagic presentation. The presence of hemorrhage, uncommon for listeria abscesses, may further complicate their detection, with consequent delayed treatment. The diagnostic hypothesis was confirmed by cerebrospinal fluid examination, which was confident with LM infection. Clinical and neuroradiological state improved after antibiotic therapy.

Progressive multifocal leukoencephalopathy (PML) is a demyelinating disease of the central nervous system (CNS) caused by John Cunningham Virus (JCV). We report four PML cases in immunocompromised patients, respectively treated with (1) Natalizumab, (2) Rituximab, (3) autologous stem-cell transplantation, and (4) Tacrolimus. All patients underwent neurological examination, magnetic resonance imaging (MRI), magnetic resonance spectroscopy (MRS), JCV-DNA research on biological samples, and lymphocytes subpopulation study. All cases presented with motor, behavioural, and cognitive disorders. Visual, sensitive, and cerebellar deficits developed in three cases. MRI revealed widespread progressive demyelinating areas with active borders; three patients presented contrast enhancement. One patient developed inflammatory reconstitution syndrome (IRIS). At MRS, all cases presented decreased N-acetyl-aspartate (NAA) and three cases showed increased choline (Cho). In one patient, plasma and urine tested positive for JCV-DNA, while cerebrospinal fluid (CSF) analysis confirmed JCV in two patients. The fourth patient had a low JCV-DNA blood titer and brain biopsy showed subacute necrosis. Two patients had abnormal lymphocyte subpopulations. Three patients underwent therapy with Mirtazapine, one of whom received Mefloquine in add-on. No clinical response was registered. Clinical onset, MRI and MRS were highly suggestive of PML in all patients, despite three cases presented contrast enhancement. In three cases JCV-DNA detection in biological samples confirmed the diagnosis. The fourth patient fulfilled diagnosis of “presumptive PML”. Our data confirm the importance to complete the diagnostic workup despite the presence of findings not completely consistent with classical PML. We hypothesize that atypical characteristics could due to the clinical conditions leading to PML., Highlights • Four cases of PML in iatrogenic immunocompromised patients. • Clinical presentation was typical for PML. • Diagnostic findings were not completely consistent with classical PML. • Atypical findings do not exclude diagnosis when clinical data are highly suggestive. • It is necessary to improve the diagnostic and therapeutic management of patients.

Bidirectional DC/DC converters such as the Split-pi can be used to integrate an energy storage system (ESS) into a DC microgrid providing manifold benefits. However, this integration deserves careful design because the ESS converter must behave like a stiff voltage generator, a non-stiff voltage generator, or a current generator depending on the microgrid configuration. Part I of this work presented a comprehensive theoretical analysis of the Split-pi used as an ESS converter in all the possible DC microgrid scenarios. Five typical microgrid scenarios were identified. Each of them required a specific state-space model of the Split-pi and a suitable control scheme. The present paper completes the study validating the theoretical analysis based on simulations and experimental tests. The chosen case study encompassed a 48 V, 750 W storage system interfaced with a 180 V DC microgrid using a Split-pi converter. It can represent a reduced-power prototype of terrestrial and marine microgrids. A prototypal Split-pi converter was realized in the lab, and several experimental tests were performed to assess the performance in each scenario. The results obtained from the experimental tests were coherent with the simulations and validated the study.

Background: Umbilical Venous Catheter (UVC) are commonly used in neonatal period; they can be not correctly positioned and could be associated with complications. The purpose of this article is to suggest a flow-chart to evaluate the placement of UVC, testing it in young radiologists-in-training. Method: We developed a simple flow-chart to asses, steps by step, UVC placement considering its course and tip location (ideally placed in the atriocaval junction). We tested the flow-chart impact asking to 20 residents to evaluate the placement of 10 UVC before and after they familiarized with the flow-chart and the anatomical findings of a newborn. The agreement among the 20 students was evaluated too. Results: The number of correct characterizations was different due to the administration of the flow-chart. One hundred and six correct UVC assessments at the beginning switched to 196 after the administration of the flow-chart (p=0.0001). The observed agreement among the twenty radiology residents was statistically significant, both before (kappa=0.41, p&nbsp

Background: High-quality intraoperative imaging is needed for optimal monitoring of patients undergoing transcranial MR-guided Focused Ultrasound (tcMRgFUS) thalamotomy. In this paper, we compare the intraoperative imaging obtained with dedicated FUS-Head coil and standard body radiofrequency coil in tcMRgFUS thalamotomy using 1.5-T MR scanner. Methods: This prospective study included adult patients undergoing tcMRgFUS for treatment of essential tremor. Intraoperative T2-weighted FRFSE sequences were acquired after the last high-energy sonication using a dedicated two-channel FUS-Head (2ch-FUS) coil and body radiofrequency (body-RF) coil. Postoperative follow-ups were performed at 48 h using an eight-channel phased-array (8ch-HEAD) coil. Two readers independently assessed the signal-to-noise ratio (SNR) and evaluated the presence of concentric lesional zones (zone I, II and III). Intraindividual differences in SNR and lesional findings were compared using the Wilcoxon signed rank sum test and McNemar test. Results: Eight patients underwent tcMRgFUS thalamotomy. Intraoperative T2-weighted FRFSE images acquired using the 2ch-FUS coil demonstrated significantly higher SNR (R1 median SNR: 10.54, R2: 9.52) compared to the body-RF coil (R1: 2.96, p &lt, 0.001, R2: 2.99, p &lt, 0.001). The SNR was lower compared to the 48-h follow-up (p &lt, 0.001 for both readers). Intraoperative zone I and zone II were more commonly visualized using the 2ch-FUS coil (R1, p = 0.031 and p = 0.008, R2, p = 0.016, p = 0.008), without significant differences with 48-h follow-up (p &ge, 0.063). The inter-reader agreement was almost perfect for both SNR (ICC: 0.85) and lesional findings (k: 0.82&ndash, 0.91). Conclusions: In the study population, the dedicated 2ch-FUS coil significantly improved the SNR and visualization of lesional zones on intraoperative imaging during tcMRgFUS performed with a 1.5-T MR scanner.

In recent years many papers about diagnostic applications of diffusion tensor imaging (DTI) have been published. This is because DTI allows to evaluate in vivo and in a non-invasive way the process of diffusion of water molecules in biological tissues. However, the simplified description of the diffusion process assumed in DTI does not permit to completely map the complex underlying cellular components and structures, which hinder and restrict the diffusion of water molecules. These limitations can be partially overcome by means of diffusion kurtosis imaging (DKI). The aim of this paper is the description of the theory of DKI, a new topic of growing interest in radiology. DKI is a higher order diffusion model that is a straightforward extension of the DTI model. Here, we analyze the physics underlying this method, we report our MRI acquisition protocol with the preprocessing pipeline used and the DKI parametric maps obtained on a 1.5 T scanner, and we review the most relevant clinical applications of this technique in various neurological diseases.

To describe clinical features of the anterior Stafne bone cyst. To supply radiologist a guide for diagnosis and classification of Stafne bone cyst.

Purpose The objective of this study was to correlate the presence and distribution of cerebral microbleeds in Alzheimer’s disease patients with cerebrospinal fluid biomarkers (amyloid-beta and phosphorylated tau 181 protein levels) and cognitive decline by using susceptibility-weighted imaging magnetic resonance sequences at 1.5 T. Material and methods Fifty-four consecutive Alzheimer’s disease patients underwent brain magnetic resonance imaging at 1.5 T to assess the presence and distribution of cerebral microbleeds on susceptibility-weighted imaging images. The images were analyzed in consensus by two neuroradiologists, each with at least 10 years’ experience. Dementia severity was assessed with the Mini-Mental State Examination score. A multiple regression analysis was performed to assess the associations between the number and location of cerebral microbleed lesions with the age, sex, duration of the disease, cerebrospinal fluid amyloid-beta and phosphorylated tau 181 protein levels, and cognitive functions. Results A total of 296 microbleeds were observed in 54 patients; 38 patients (70.4%) had lobar distribution, 13 patients (24.1%) had non-lobar distribution, and the remaining three patients (5.6%) had mixed distribution, demonstrating that Alzheimer’s disease patients present mainly a lobar distribution of cerebral microbleeds. The age and the duration of the disease were correlated with the number of lobar cerebral microbleeds ( P Conclusion Lobar distribution of cerebral microbleeds is associated with Alzheimer’s disease and the number of lobar cerebral microbleeds directly correlates with cerebrospinal fluid amyloid-beta and phosphorylated tau 181 protein levels and with the cognitive decline of Alzheimer’s disease patients.

We present a cognitive architecture whose main constituents are allowed to grow through a situated experience in the world. Such an architectural growth is bootstrapped from a minimal initial knowledge and the architecture itself is built around the biologically-inspired notion of internal models. The key idea, supported by findings in cognitive neuroscience, is that the same internal models used in overt goal-directed action execution can be covertly re-enacted in simulation to provide a unifying explanation to a number of apparently unrelated individual and social phenomena, such as state estimation, action and intention understanding, imitation learning and mindreading. Thus, rather than reasoning over abstract symbols, we rely on the biologically plausible processes firmly grounded in the actual sensorimotor experience of the agent. The article describes how such internal models are learned in the first place, either through individual experience or by observing and imitating other skilled agents, and how they are used in action planning and execution. Furthermore, we explain how the architecture continuously adapts its internal agency and how increasingly complex cognitive phenomena, such as continuous learning, prediction and anticipation, result from an interplay of simpler principles. We describe an early evaluation of our approach in a classical AI problem-solving domain: the Sokoban puzzle.

Magnetic Resonance is actually the most complete and less invasive imaging technique in the evaluation of Crohn’s disease. Compared to Computed Tomography and Ultrasound, Magnetic Resonance allows both a morphological and qualitative evaluation of the disease at the same time, thus allowing an evaluation of its extension in the gastrointestinal tract and of its grade of activity, obtaining an accurate relation with the clinical status of the patient. This is possible thanks to its intrinsic characteristics, as multiplanarity, high contrast resolution, and the possibility to make a functional assessment; moreover, there is no use of ionizing radiation. For all these reasons, this technique has a high diagnostic potential.

SCOPO DEL LAVORO Presentiamo il caso di una donna di 63 anni con storia di pseudotumor orbitae e diagnosi tardiva di Malattia di Erdheim-Chester (MEC) con coinvolgimento multisistemico e rare localizzazioni a livello splancno- ed intracranico. MATERIALI E METODI La paziente, a causa della comparsa di astenia progressivamente ingravescente, vomito e disfagia per i solidi veniva condotta al PS dove eseguiva ECG ed esami ematochimici e veniva ricoverata con la diagnosi di disidratazione e squilibrio elettrolitico. L’esame obiettivo evidenziava pallore e disidratazione di cute e mucose, ipotrofia muscolare e proptosi bulbare bilaterale da pseudotumor orbitario infiammatorio cronico con evidenti secrezioni purulente. La paziente veniva quindi sottoposta a Esofago-Gastro-Duodenoscopia (che non ha mostrato significativi reperti) e TC total body (Siemens SOMATOM Definition AS+ - 128 strati). Nel sospetto di una patologia sistemica a carattere fibrosclerotico-istiocitario, veniva richiesta una rivalutazione immunoistochimica su un prelievo bioptico eseguito, oltre un anno addietro, nel seno mascellare destro, che aveva evidenziato tessuto fibrovascolare con infiltrato flogistico linfocitario e raccolte di istiociti schiumosi. Venivano inoltre eseguite RM encefalo con apparecchiatura da 1,5 Tesla (GE Signa HDxt) prima e dopo mdc e.v. e PET total body con ¹⁸F-FDG. Durante la degenza è stata somministrata antibioticoterapia sistemica e topica oculare con aminoglicoside, steroidi a basse dosi ed analgesici, con progressivo miglioramento del quadro infiammatorio locale orbitario e degli indici sistemici di flogosi. RISULTATI La TC total body ha evidenziato segni di diffuso interessamento del distretto cranio-encefalico, di rimaneggiamento osseo diffuso e di coinvolgimento polmonare e retroperitoneale. La RM encefalo mostrava la presenza di tessuto di intensità intermedia in T1 e bassa in T2, dotato di intensa impregnazione post-contrastografica, a localizzazione transcompartimentale splancno- ed intra-cranica (meningi, ependima, plessi corioidei, seno cavernoso, spazi perivasali, orbite e seni paranasali): in particolare a livello orbitario erano interessati bulbi oculari, nervi ottici, muscolatura estrinseca e ghiandole lacrimali; di rilievo inoltre il coinvolgimento, a livello intracranico, dei plessi corioidei in corrispondenza del corno temporale del ventricolo laterale di sinistra e dei recessi del IV ventricolo e, a livello dello splancnocranio, del canale carotideo, del foro lacero posteriore e l’infiltrazione perivasale intorno alla carotide interna nei suoi tratti intrapetroso ed intracavernoso. La PET meglio definiva l’interessamento multisistemico. La valutazione immunoistochimica degli elementi istiocitari risultava positiva al CD68 e negativa al CD1a/S100. CONCLUSIONI I dati dell’analisi immunoistochimica hanno permesso di confermare la diagnosi di MEC, una rara istiocitosi a cellule non-Langerhans, caratterizzata da infiltrazione tissutale di istiociti schiumosi e coinvolgimento multisistemico. La diagnosi di ECD è spesso insidiosa e tardiva, nonostante la presenza di alcuni tipici segni clinici e radiologici, non sempre riconosciuti e ricondotti a questa patologia. In particolare l’interessamento del SNC si riscontra in circa il 50% dei pazienti affetti. Nel nostro caso la paziente è giunta alla nostra osservazione in uno stadio ormai avanzato di malattia con localizzazioni infrequenti a livello intracranico: in particolare estremamente rari risultano le caratteristiche del coinvolgimento orbitario, l’infiltrazione perivasale e la localizzazione nei plessi corioidei.

Gastrointestinal lymphomas represent 5–20% of extranodal lymphomas and mainly occur in the stomach and small intestine. Clinical findings are not specific, thus often determining a delay in the diagnosis. Imaging features at conventional and cross-sectional imaging must be known by the radiologist since he/she plays a pivotal role in the diagnosis and disease assessment, thus assisting in the choice of the optimal treatment to patients. This review focuses on the wide variety of imaging presentation of esophageal, gastric, and small and large bowel lymphoma presenting their main imaging appearances at conventional and cross-sectional imaging, mainly focusing on computed tomography and magnetic resonance, helping in the choice of the best imaging technique for the disease characterization and assessment and the recognition of potential complications.

Endometriosis is an important gynecologic disorder defined as the presence of functional endometrial glands and stroma outside the uterine cavity. Prevalence of endometriosis is 6-10% in the general population, but rises to 35-50% in women with pelvic pain or infertility or both. The aim of this study was to retrospectively review the different locations of pelvic and extrapelvic endometriosis occurred in our Department during last 3 years.