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Background The plasma cell disease is been studying by the whole-body MRI technology. However, the time requested to learn this radiological technique is unknown. Purpose To esteem, quantitatively and qualitatively, the essential time to learn the whole-body MRI diffusion-weighted imaging with background body signal suppression in patients with plasma cell disease. Materials and methods Between January 2015 and February 2017, three readers in-training with different levels of experience examined the anonymised and randomised whole-body MRI images of 52 patients with a diagnosis of plasma cell disease and analysed their morphological (T1w, T2w with and without fat suppression) and functional sequences. Reports of an expert radiologist were considered the standard of reference. Images were analysed in two sessions, during which each reader was timed. Readers reported the number of segments with lesions and staged the disease using the Durie–Salmon PLUS staging system. Weighted Cohen’s ĸ and Z-test were used to compare the trainees’ reports with those of the expert radiologist, and learning curves were drawn up to show changes between the two sessions. Results Weighted Cohen’s ĸ of number of lesioned segments increased from 0.536 ± 0.123 to 0.831 ± 0.129 (Prob > Z under 0.005), thus approaching the goal of ĸ > 0.8. Trainees reached the level of experienced radiologist in terms of time by the 33rd patient. Agreement concerning the Durie–Salmon PLUS increased from 0.536 ± 0.123 to 0.831 ± 0.129 (Prob > Z under 0.005). Conclusions The findings of this study demonstrate that whole-body MRI with DWIBS can be learned in about 80 reports and leads to a high level of inter-observer concordance when using the Durie–Salmon PLUS staging system.

Whole-body magnetic resonance imaging is constantly gaining more importance in rheumatology, particularly for what concerns the diagnosis, follow-up, and treatment response evaluation. Initially applied principally for the study of ankylosing spondylitis, in the last years, its use has been extended to several other rheumatic diseases. Particularly in the pediatric population, WB-MRI is rapidly becoming the gold-standard technique for the diagnosis and follow-up of both chronic recurrent multifocal osteomyelitis and juvenile spondyloarthritis. In this review, we analyze the benefits and limits of this technique as well as possible future applications.

Objective: The aim of this work is to evaluate the diagnostic accuracy of 0.3T sectoral MR imaging, compared with arthroscopy, for meniscal, cruciate ligaments and chondral knee lesions. Materials and Methods: We conducted a retrospective study analyzing all the consecutive knees subjected to arthroscopy at our institution between January 2014 and June 2017 and preceded within 3 months by knee MR examination at our institution with 0.3 T equipment. Patients with history of a new trauma in the time interval between MR exam and arthroscopy were excluded from the study. Two independent experienced radiologists evaluated in double blind the MR findings of menisci, cruciate ligaments and articular cartilage. Both radiological findings were independently compared with those of the arthroscopic report considered as gold standard. For each of the examined targets we calculated the following parameters: sensitivity, specificity, accuracy, positive and negative predictive value; interobserver concordance statistically calculated using Cohen’s Kappa test. Results: 214 knees (95R/119L) of 214 patients (143M/71F) aged from 18 to 72 years (mean 44) were included and analyzed. We found a good diagnostic accuracy of the low field MR in identifying the injuries of the menisci (93%) and the crossed ligaments (96%), but a lower accuracy for the articular cartilage (85%). Sensitivity resulted 90% for menisci, 73% for ligaments and 58% for cartilage. Specificity was 91% for menisci, 97% for ligaments and 92% for cartilage. Inter-observer concordance resulted to be excellent for cruciate ligaments (K of Cohen’s test = 0.832), good (K = 0.768) for menisci, modest to moderate for articular cartilage (K from 0.236 to 0.389) with worse concordance for tibial cartilage. Conclusions: Low-field MR sectoral device with dedicated joint equipment confirms its diagnostic reliability for the evaluation of meniscal and cruciate ligaments lesions but is weak in evaluating low grade chondral lesions. (www.actabiomedica.it)

Background: Arthroscopic cuff repair is a highly successful technique, but postoperative rehabilitation is complex and the rate of tear recurrence is not negligible. Biological augmentations have been proposed to overcome these drawbacks. The platelet-rich plasma (PRP) is a platelet-rich blood fraction that is applied on the repair site to enhance tendon healing. This study evaluates the effectiveness of PRP application in arthroscopic cuff repair. Materials and Methods: A prospective nonrandomized study was carried out on 22 patients undergoing arthroscopic rotator cuff repair. Only patients with isolated and repairable supraspinatus tears were included and divided into two groups: 11 patients (Group A) received intraoperative PRP and 11 patients (Group B) did not. All patients had the same rehabilitation and followup protocol. Clinical–functional parameters (visual analog score, active range of motion, University of California at Los Angeles - UCLA, Constant) were recorded at predefined intervals, and magnetic resonance imaging (MRI) was performed 1 year postoperative. Results: Only one patient of Group B did not complete the study protocol. No intraoperative or postoperative complications were observed. No differences were found in the clinical–functional parameters during the entire study. At 1 year, MRI showed 1 retear in Group A and 2 retears in Group B, but the difference was not significant. Conclusions: The role of PRP as an adjuvant for surgical repair of rotator cuff tears is controversial. In this study, we could not demonstrate significant advantages of PRP for arthroscopic repair of isolated supraspinatus tears. The potential improvement in the structural outcome should be evaluated in the long term to justify the additional costs related to PRP application.

To quantitatively compare the artefact reduction between standard and metallic artefact reduction (MAR) fast spin echo (FSE) T2 sequences in a low-field magnetic resonance imaging (MRI) scanner (0.3 T) in patients with titanium volar wrist plating. Sixteen patients with fractures of the distal radius, treated with titanium volar wrist plating and screws, were examined using a dedicated 0.3 T MRI scanner. Coronal standard FSE T2, FSE T2 high bandwidth (HiBW) and FSE T2 view angle tilting (VAT) sequences were performed. Metallic artefact volume, consisting of both “black” and “bright” artefacts, was calculated for each sequence. Quantitative differences were compared using repeated measures ANOVA test (P

Background: Traumatic brachial plexus injuries are rare but serious consequences of major traumas. Pre-ganglionic lesions are considered irreparable, while post-ganglionic injuries can be potentially treated if an early diagnosis is available. Pre-surgical diagnosis is important to distinguish low-grade from high-grade lesions and to identify their location. The aim of the review is to evaluate the diagnostic accuracy of magnetic resonance imaging (MRI) in the identification of adult post-ganglionic lesions due to traumatic brachial plexus injuries, compared to intraoperative findings. Methods: Research on the main scientific electronic databases was conducted. Studies of adults with traumatic post-ganglionic brachial plexus injuries were included. The index test was preoperative MRI and the reference standard was surgical exploration. Pooled sensitivity and specificity were calculated. Results: Four studies were included for the systematic review, of which three articles met the inclusion criteria for the meta-analysis. Pooled sensitivity and pooled specificity values resulted high. The sensitivity value is associated with a high heterogeneity index of the selected literature. Conclusion: MRI can be considered, despite the limits, the gold standard exam in morphological evaluation of brachial plexus injuries, particularly in the diagnosis of post-ganglionic traumatic injuries.

In amyotrophic lateral sclerosis (ALS), magnetic resonance imaging (MRI) allows investigation at the microstructural level, employing techniques able to reveal white matter changes. In the current study, a diffusion tensor imaging (DTI) analysis, with a collection of apparent diffusion coefficient (ADC) and fractional anisotropy (FA) indexes, was performed in ALS patients to correlate geno- and phenotype features with MRI data, to investigate an in-vivo correlation of different neuropathological patterns. All patients who underwent the MR-DTI analysis were retrospectively recruited. MRI scan was collected within three months from diagnosis. FA and ADC values were collected in corpus callosum (CC), corona radiata (CR), cerebral peduncle (CR), cerebellar peduncle (CbP) and corticospinal tract at posterior limb of internal capsule (CST). DTI analysis performed in the whole ALS cohort revealed significant FA reduction and ADC increase in all selected regions, as widespread changes. Moreover, we observed a higher value of FA in rCR in bulbar patients. A positive correlation between ALS Functional Rating Scale-Revised and FA in rCP was evident. In consideration of the non-invasiveness, the reliability and the easy reproducibility of the method, we believe that brain MRI with DTI analyses may represent a valid tool usable as a diagnostic marker in ALS.

Summary Objectives The esophageal speech is one of the possible alaryngeal voices resulting after total laryngectomy. Its production is made by the regurgitation of the air coming from the esophagus, sonorized through the passage from the walls of the upper esophageal sphincter. The neural correlates of this voice have never been investigated, while the neural control of laryngeal voice has been already documented by different studies. Methods Four patients using esophageal speech after total laryngectomy and four healthy controls underwent functional magnetic resonance imaging. The fMRI experiment was carried out using a “Block Design Paradigm.” Results Comparison of the phonation task in the two groups revealed higher brain activities in the cingulate gyrus, the cerebellum and the medulla as well as lower brain activities in the precentral gyrus, the inferior and middle frontal gyrus and the superior temporal gyrus in the laryngectomized group. Conclusions The findings in this pilot study provide insight into neural phonation control in laryngectomized patients with esophageal speech. The imaging results demonstrated that in patients with esophageal speech, altered brain activities can be observed. The adaptive changes in the brain following laryngectomy reflect the changes in the body and in the voice modality. In addition, this pilot study establishes that a blocked design fMRI is sensitive enough to define a neural network associated with esophageal voice and lays the foundation for further studies in this field.

Purpose: To perform a survey among all members of the Italian Society of Medical and Interventional Radiology (SIRM) to assess how whole-body MRI (WB-MRI) is performed in oncologic patients in Italy. Methods: On March 2019, we administered an online poll to all SIRM members about their use of WB-MRI in 2018 asking 15 questions regarding oncologic indications, imaging protocol, use of contrast media, experience in WB-MRI, duration of scan time and reporting time. Results: Forty-eight members participated to the survey. WB-MRIs/total MRIs ratio was 1%. Lymphoma was the most common indication (17/48, 35%), followed by myeloma and prostate cancer, with these three tumors representing the most common indication in 39/48 of cases (81%). WB-MRI acquisition time and reporting time were 46–60min in 22/48 centers (46%) and 20–30min in 19/48 (40%), respectively. WB-MRIs were mostly performed in 1.5T scanners (43/48, 90%), with surface coils (22/48, 46%) being preferred to Q-body (15/48, 31%) and integrated coils (11/48, 23%). Contrast media were injected in 22/48 of the centers (46%), mainly used for breast cancer (13/22, 59%). DWI was the most used sequence (45/48, 94%), mostly with b800 (27/48, 56%), b0 (24/48, 50%) and b1000 (20/48, 42%) values. In about half of cases, radiologists started evaluating WB-MRI non-contrast morphologic sequences, then checking DWI and post-contrast images. Conclusion: WB-MRI was mainly performed at 1.5T unit, with lymphoma, myeloma and prostate cancer having been the most common indications. The extreme variability in the choice of imaging protocols and use of contrast agents demonstrates the need of a standardization of WB-MRI application in clinical practice.

Quantitative bone marrow (BM) MR sequences, as DWI and CSI, were used to evaluate BM water–fat composition. The aim of the study was to assess the potential usefulness of fat fraction (FF) and ADC, calculated by CSI or DWI, in diagnosing and classifying myeloma (MM) patients according to their different BM infiltration patterns. The study group included 43 MM patients (19F; 24M; mean age 64 years), 15 asymptomatic, 15 symptomatic with diffuse BM infiltration and 13 symptomatic with focal lesions (FLs). The control group was made up of 15 healthy subjects (7F; 8M; mean age 64 years). MRI examinations consisted of sagittal T1w TSE on the spinal column, axial DWI (b 50–400–800 mm2/s) and coronal T2 Dixon, on the whole body. Mean ADC and FF were calculated placing 1 ROI on 6 vertebras and 2 ROIs on either the pelvis or FL. ANOVA with Bonferroni’s correction showed a significant difference in ADC values among the different groups of MM patients (P

Whole-body MRI (WB-MRI) with diffusion-weighted imaging (DWI) can now be used to stage and restage multiple myeloma (MM) and lymphoma. Magnetic resonance imaging (MRI) is the standard tool to detect BM involvement (BMI). The 2016 diagnostic criteria of the International Myeloma Working Group identify WB-MRI and fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) as the most sensitive imaging techniques for detecting skeletal and extra-skeletal MM invasion, respectively. Preliminary findings have also shown that WB-MRI is better than CT and equal to PET/CT in staging aggressive lymphoma and Hodgkin lymphoma, whereas MRI is better for diagnosing BMI in patients with low-grade lymphoma. Signal intensity (SI) and the apparent diffusion coefficient (ADC) are useful metrics to quantify the chemotherapy response in WB-MRI.

The main objective of this phase I trial was to assess the feasibility and safety of microtransplanting human neural stem cell (hNSC) lines into the spinal cord of patients with amyotrophic lateral sclerosis (ALS). Eighteen patients with a definite diagnosis of ALS received microinjections of hNSCs into the gray matter tracts of the lumbar or cervical spinal cord. Patients were monitored before and after transplantation by clinical, psychological, neuroradiological, and neurophysiological assessment. For up to 60 months after surgery, none of the patients manifested severe adverse effects or increased disease progression because of the treatment. Eleven patients died, and two underwent tracheotomy as a result of the natural history of the disease. We detected a transitory decrease in progression of ALS Functional Rating Scale Revised, starting within the first month after surgery and up to 4 months after transplantation. Our results show that transplantation of hNSC is a safe procedure that causes no major deleterious effects over the short or long term. This study is the first example of medical transplantation of a highly standardized cell drug product, which can be reproducibly and stably expanded ex vivo, comprising hNSC that are not immortalized, and are derived from the forebrain of the same two donors throughout this entire study as well as across future trials. Our experimental design provides benefits in terms of enhancing both intra- and interstudy reproducibility and homogeneity. Given the potential therapeutic effects of the hNSCs, our observations support undertaking future phase II clinical studies in which increased cell dosages are studied in larger cohorts of patients. Stem Cells Translational Medicine 2019;8:887–897

We describe a 64-year-old woman, suffering from late-onset obsessive–compulsive disorder (OCD) from the age of 57, who developed dysarthria and dysphagia, spastic diplegic, and proximal muscles weakness. Needle electromyography showed no active denervation. Neuropsychological evaluation showed intact cognitive functioning. We diagnosed upper motor neuron disease (MND), with no known genetic correlates. Brain magnetic resonance (MRI) detected bilateral hippocampal atrophy with sclerosis of right hippocampus. 18F-FDG positron emission tomography (PET) showed moderate right temporal cortex thinning. Six months later, motor and behavioral symptoms worsened. Neuropsychological examination revealed long-term memory deficit and executive dysfunction. MRI and PET evidenced severe worsening of atrophy in temporal and frontal lobes. Four years later a definitive diagnosis of primary lateral sclerosis (PLS) and FTD was made. To our knowledge, this is the first report of PLS and FTD with OCD at onset.

Aqueductal stroke volume (ACSV) measured by phase-contrast cine (PCC)-MRI has been proposed with controversy as a tool for the selection of patients with normal pressure hydrocephalus (NPH) as candidates for shunt-surgery. The aim of this study was to assess if PCC-MRI scan measurements of ACSV could select properly these patients.We retrospectively reviewed charts and MRI of 38 shunted patients (72.16±6.16 years). ACSV measurements were performed 7-30 days before shunt and at the first and sixth months after surgery. Normally distributed variables were compared in the two groups (improved/unimproved) by t-test for baseline values and with repeated measures analysis of variance.Twenty-six patients (68,4%) improved after VPS (mean time of symptom onset was 8.15±7.19 months). Mean preoperative ACSV value was 271.85±143.03, which decreased by 21.6% (mean 213±125.14) at the first month and 40.3% sixth months after VPS (mean 162.15±91.5). Twelve patients (31.6%) did not improve (mean time of symptom onset was 29±5.62 months). Mean preoperative ACSV value was 79.83±31.24, decreased to 8.7% (mean 72.83±28.66) at first month after VPS. 21.2% (mean 62.83±31.12) after six months. We found statistical difference between preoperative ACSV of improved and unimproved patients (P0.01), onset time of symptoms (P0.01) and the changes in ACSV after one and six months in both groups (P0.001).ACSV is useful to stratify patients with NPH after surgery (improved /not improved) suggesting to proceed with serial ACSV measurements before deciding treatment.

Amyotrophic Lateral Sclerosis (ALS) is an incurable neuro-degenerative disease that lacks specific biomarkers. Hence, for the accuracy of diagnosis, a definite exclusion of ALS-mimic syndromes is m...

BACKGROUND The aim of this study was to assess whether the early monitoring of the effects of bevacizumab in patients with recurrent glioblastoma multiforme (GBM) using perfusional dynamic susceptibility contrast (DSC) magnetic resonance imaging (MRI) before and after the beginning of antiangiogenic therapy is predictive of treatment response. METHODS Thirteen patients with recurrent GBM underwent perfusion MRI with relative cerebral blood volume (rCBV) mapping before (T0) and after the beginning (T1) of bevacizumab treatment. Recurrence Regions of Interest (RoIs) were positioned on the enhancing component of tumoral tissue revealed by postcontrast T1-weighted images. The rCBV measurements on the corresponding maps were made before and after the start of the antiangiogenic therapy. The Cox proportional hazards model and the Kaplan-Meier method were used with the log-Rank Test to establish whether pre- and postbevacizumab rCBV predicted progression-free survival (PFS). We tried to assess if there was a correlation between rCBV at T0 and rCBV at T1 using the Pearson's correlation coefficient. RESULTS In the univariable analysis, rCBV was significantly predictive of PFS at T0 (HR=5.3, P=0.003) and at T1 (HR=4.14, P=0.04). Similarly, in the multivariate Cox model analysis, rCBV was predictive of PFS at T0 (HR=4.4, P=0.04) and T1 (HR=4.2, P=0.02). PFS was longer in patients whose rCBV was less than 4.50 mL/100g at T0 and less than 1.83 mL/100g at T1 than in patients with higher rCBV values. There was a moderate positive correlation between rCBV at T0 and rCBV at T1 (P=0.032, R=0.546). CONCLUSIONS Despite the limited number of enrolled patients, rCBV assessed using DSC-MRI through the parameter rCBV is proved reliable in predicting the effects of antiangiogenic treatment in patients with recurrent GBM.

A concern for researchers planning multisite studies is that scanner and T1-weighted sequence-related biases on regional volumes could overshadow true effects, especially for studies with a heterogeneous set of scanners and sequences. Current approaches attempt to harmonize data by standardizing hardware, pulse sequences, and protocols, or by calibrating across sites using phantom-based corrections to ensure the same raw image intensities. We propose to avoid harmonization and phantom-based correction entirely. We hypothesized that the bias of estimated regional volumes is scaled between sites due to the contrast and gradient distortion differences between scanners and sequences. Given this assumption, we provide a new statistical framework and derive a power equation to define inclusion criteria for a set of sites based on the variability of their scaling factors. We estimated the scaling factors of 20 scanners with heterogeneous hardware and sequence parameters by scanning a single set of 12 subjects at sites across the United States and Europe. Regional volumes and their scaling factors were estimated for each site using Freesurfer's segmentation algorithm and ordinary least squares, respectively. The scaling factors were validated by comparing the theoretical and simulated power curves, performing a leave-one-out calibration of regional volumes, and evaluating the absolute agreement of all regional volumes between sites before and after calibration. Using our derived power equation, we were able to define the conditions under which harmonization is not necessary to achieve 80% power. This approach can inform choice of processing pipelines and outcome metrics for multisite studies based on scaling factor variability across sites, enabling collaboration between clinical and research institutions. publisher: Elsevier articletitle: Power estimation for non-standardized multisite studies journaltitle: NeuroImage articlelink: http://dx.doi.org/10.1016/j.neuroimage.2016.03.051 content_type: article copyright: © 2016 The Authors. Published by Elsevier Inc. ispartof: NeuroImage vol:134 pages:281-294 ispartof: location:United States status: published

Balò's sclerosis is considered a rare variant of multiple sclerosis characterized by demyelination with concentric rings. Advanced magnetic resonance studies allow nowadays early diagnosis and prompt treatment. However, the pathophysiology of lesion evolution is still matter of debate, as detailed in our literature review. Based on a clear-cut Balò's lesion analysis, we describe early changes in DWI and ADC values within the different layers, favoring the concept of a centrifugal growth.

Whole body magnetic resonance imaging (MRI) with diffusion-weighted imaging (WB-MRI-DWI) is currently emerging as a diagnostic technique in the evaluation of bone metastases from breast, prostate, lung, thyroid, and melanoma tumors. The most relevant articles regarding the detection of solid tumor bone metastases with MRI have been reviewed and cited. The imaging methods currently used in the detection of bone metastases are bone scintigraphy, computed tomography (CT), and positron emission tomography (PET/CT) with 2-deoxy-2-[fluorine-18] fluoro-d-glucose (18F-FDG PET/CT). WB-MRI-DWI allows qualitative and quantitative evaluation of focal lesions through signal intensity evaluation on DWI images and the reconstruction of the apparent diffusion coefficient (ADC) map. In prostate and breast cancer, WB-MRI-DWI is useful in assessing the response of bone lesions to therapy and to detecting early non-responders, while in lung cancer the method shows a similar sensitivity to 18F-FDG PET/CT in the detection of bone metastases. In bone metastases of thyroid tumors and melanoma, the WB-MRI-DWI shows a higher sensitivity when compared to 18F-FDG PET/CT. With a standardization of the WB-MRI-DWI protocol, this method seems to play an important role in the diagnosis of bone solid tumor metastases.

Importance Chronic cerebrospinal venous insufficiency (CCSVI) is characterized by restricted venous outflow from the brain and spinal cord. Whether this condition is associated with multiple sclerosis (MS) and whether venous percutaneous transluminal angioplasty (PTA) is beneficial in persons with MS and CCSVI is controversial. Objective To determine the efficacy and safety of venous PTA in patients with MS and CCSVI. Design, Setting, and Participants We analyzed 177 patients with relapsing-remitting MS; 62 were ineligible, including 47 (26.6%) who did not have CCSVI on color Doppler ultrasonography screening. A total of 115 patients were recruited in the study timeframe. All patients underwent a randomized, double-blind, sham-controlled, parallel-group trial in 6 MS centers in Italy. The trial began in August 2012 and concluded in March 2016; data were analyzed from April 2016 to September 2016. The analysis was intention to treat. Interventions Patients were randomly allocated (2:1) to either venous PTA or catheter venography without venous angioplasty (sham). Main Outcomes and Measures Two primary end points were assessed at 12 months: (1) a composite functional measure (ie, walking control, balance, manual dexterity, postvoid residual urine volume, and visual acuity) and (2) a measure of new combined brain lesions on magnetic resonance imaging, including the proportion of lesion-free patients. Combined lesions included T1 gadolinium-enhancing lesions plus new or enlarged T2 lesions. Results Of the included 115 patients with relapsing-remitting MS, 76 were allocated to the PTA group (45 female [59%]; mean [SD] age, 40.0 [10.3] years) and 39 to the sham group (29 female [74%]; mean [SD] age, 37.5 [10.6] years); 112 (97.4%) completed follow-up. No serious adverse events occurred. Flow restoration was achieved in 38 of 71 patients (54%) in the PTA group. The functional composite measure did not differ between the PTA and sham groups (41.7% vs 48.7%; odds ratio, 0.75; 95% CI, 0.34-1.68;P = .49). The mean (SD) number of combined lesions on magnetic resonance imaging at 6 to 12 months were 0.47 (1.19) in the PTA group vs 1.27 (2.65) in the sham group (mean ratio, 0.37; 95% CI, 0.15-0.91;P = .03: adjustedP = .09) and were 1.40 (4.21) in the PTA group vs 1.95 (3.73) in the sham group at 0 to 12 months (mean ratio, 0.72; 95% CI, 0.32-1.63;P = .45; adjustedP = .45). At follow-up after 6 to 12 months, 58 of 70 patients (83%) in the PTA group and 22 of 33 (67%) in the sham group were free of new lesions on magnetic resonance imaging (odds ratio, 2.64; 95% CI, 1.11-6.28;P = .03; adjustedP = .09). At 0 to 12 months, 46 of 73 patients (63.0%) in the PTA group and 18 of 37 (49%) in the sham group were free of new lesions on magnetic resonance imaging (odds ratio, 1.80; 95% CI, 0.81-4.01;P = .15; adjustedP = .30). Conclusion and Relevance Venous PTA has proven to be a safe but largely ineffective technique; the treatment cannot be recommended in patients with MS. Trial Registration clinicaltrials.gov Identifier:NCT01371760

Purpose To evaluate the morphostructural and functional modifications of the temporomandibular joint and the onset of parotid complications in patients with extracapsular monocondylar fractures treated by reduction with the application of a titanium microplate via a transparotid approach. Materials and Methods The study was comprised of 20 patients (16 male patients and 4 female patients) with a mean age of 25 years (range, 15-44 years) who had undergone reduction of condyle fractures. Twelve months after surgery, all patients were examined by means of magnetic resonance imaging (MRI) of the temporomandibular joint and parotid gland on the treated side. MRI examination was performed by use of coronal T2-weighted turbo spin echo sequences, as well as parasagittal T1-weighted turbo spin echo and T2-weighted fast field echo sequences. Images were acquired from the resting position to the position of maximum oral opening. Results The 1-year clinical outcome in our patients was good. MRI showed, on the treated side, 5 cases of anterior dislocation of the disc (25%), 1 case of disc degeneration (5%), and 1 case of parotid fistula (5%). Conclusion Both trauma and surgical intervention can damage the meniscal capsuloligamentous complex. MRI allowed the complications due to the trauma and/or treatment to be identified and made it possible to compare the condyles and joint function.

This study was performed to assess the feasibility, interobserver variability, sensitivity, specificity and diagnostic accuracy of raw data and postprocessed images from a low-field (0.5-T) magnetic resonance (MR) unit in evaluating vascular complications of kidney grafts. We enrolled 49 patients undergoing MR angiography (MRA) for a clinical suspicion of renal artery stenosis. The raw data, maximum intensity projections (MIP) and multiplanar reconstruction (MPR) image sets were evaluated independently. We calculated the number and degree of stenosis, and sensitivity, specificity and accuracy for MIP, MPR and raw data image sets, together with interobserver variability. Interobserver agreement was substantial. There were no differences among the MIP and MPR algorithms and raw data images for the detection of stenosis. Raw data images were more accurate in quantifying the severity of stenosis, with higher sensitivity (75% vs. 62.5%), equal specificity and higher diagnostic accuracy (75% vs. 71.43%). Contrast-enhanced MRA, even with a low-field (0.5-T) unit, is a feasible, sensitive and accurate technique for the study of the renal arteries of the transplanted kidney.

Background Crowned dens syndrome (CDS) is a clinical-radiological entity characterized by acute attacks of neck pain with fever, rigidity, general signs of inflammation, and calcification of the periodontoid articular structures. Methods Case report with 42 months follow-up. Case description An 81-year-old man, who had never suffered from headache before July 2010, developed strictly left-sided headaches. The pain was restricted to the left side of the scalp and felt more intense in the frontal area. The intensity was moderate to high with a throbbing quality. The pain had an orthostatic component and was worsened by neck hyperextension and Valsalva maneuvers. Neurological and general examinations were normal, except for a reduced range of motion of the neck. He was prescribed indomethacin orally 25 mg t.i.d. and had a partial response. After a week, he was given a dosage of 50 mg t.i.d. with complete remission of the pain. Brain magnetic resonance imaging was normal, while an magnetic resonance imaging of the cervical spine showed a non-homogeneous mass behind the odontoid process of C2, narrowing the subarachnoid space in C1, stretching the posterior longitudinal ligament, and touching the left vertebral artery. A computed tomography scan showed calcification of the soft tissue around the odontoid process and a thickening of the left C2 root. After 4 months, the indomethacin dosage was reduced step-by-step. Indomethacin was discontinued in March 2012. Since then, the headache has not recurred. Discussion We here present the case of a patient with headache and radiological findings of crowned dens. However, the clinical presentation differed from previous CDS cases in the literature in that the pain was unilateral with frontal localization and throbbing quality, as well as an orthostatic component and lack of either fever or inflammatory signs. The differential diagnosis also includes a remitting form of hemicrania continua, presenting with an atypical presentation, with neuroimaging incidental finding of CDS. Conclusion This case widens the spectrum of the clinical presentation of crowned dens, a condition that should be kept in mind in cases of unilateral headache in older patients.

Antiphospholipid syndrome (APS) is an autoimmune disorder characterized by recurrent thrombotic events and/or pregnancy morbidity that may be isolated (Primary APS) or associated with other diseases, mainly of autoimmune origin (Secondary APS). A variety of neurological symptoms may occur in association with the disease, including movement disorders. We report on a 79 year old woman with an unremarkable past medical history who progressively developed psychomotor agitation and insomnia through a period of four months, followed by an acute onset complex hyperkinetic syndrome with chorea, focal left foot dystonia, oral dyskinesias and severe speech impairment. Brain MRI showed multiple subcortical lesions without basal ganglia involvement, and a large cortical lesion in the left posterior temporal lobe that appeared to be ischemic. These findings along with a strongly elevated titer of anticardiolipin (aCL) and anti-beta(2) glycoprotein-I antibodies and positive Lupus Anticoagulant (LAC) suggested a diagnosis of Antiphospholipid Syndrome, confirmed 14 weeks later as a Primary syndrome. The autoimmune mechanisms possibly responsible for the patient's clinical picture are discussed. This case underlines the importance of taking into account APS as a cause of unusual movement disorders even in elderly patients without evidence of previous thrombotic events.

Computed tomography (CT) is the gold standard for evaluating glenoid bone loss in patients with glenohumeral dislocations. The aim of this study was to verify if magnetic resonance imaging (MRI) can quantify the area of bone loss without any significant difference from CT.Twenty-three patients, who had experienced one or more post-traumatic unilateral glenohumeral dislocations, underwent MRI and CT. MR and multiplanar reconstruction CT images were acquired in the sagittal plane: the glenoid area and the area of bone loss were calculated using the PICO method. Mean values, percentages, Cohen's kappa coefficients and Bland-Altman plots were all used to confirm the working hypothesis.The mean glenoid surface area was 575.29 mm(2) as measured by MRI, and 573.76 mm(2) as measured by CT; the calculated mean glenoid bone loss was respectively 4.38% and 4.34%. The interobserver agreement was good (k0.81), and the coefficient of variance was 5% of the mean value using both methods. The two series of measurements were within two standard deviations of each other.MRI is a valid alternative to CT for measuring glenoid bone loss in patients with glenohumeral dislocation.

Background aims. Mesenchymal stem cells/marrow stromal cells (MSC) represent a promising tool for stem cell-based clinical trials in amyotrophic lateral sclerosis (ALS). We present the results of long-term monitoring of 19 ALS patients enrolled in two phase I clinical trials of autologous MSC transplantation. Methods. Nineteen patients (11 male and eightfemale) with ALS were enrolled in two consecutive phase I clinical trials. The patients were followed-up for 6-9 months and then treated with autologous MSC isolated from bone marrow and implanted into the dorsal spinal cord with a surgical procedure. The patients were monitored regularly before and after transplantation with clinical, psychological and neuroradiologic assessments every 3 months, at the tertiary referral ALS center in Novara (Italy), until death. Results. Follow-up brain magnetic resonance imaging (MRI) revealed no structural changes (including tumor formation) relative to the baseline throughout the follow-up. There was no deterioration in the psychosocial status and all patients coped well. No clear clinical benefits were detected in these patients but the recruitment and selection of appropriate patients into larger trials will be needed to test the efficacy of the treatment. Conclusions. This study is the first to show the safety of MSC transplantation in the central nervous system during a follow-up of nearly 9 years, and is in support of applying MSC-based cellular clinical trials to neurodegenerative disorders.

This study was done to determine the diagnostic value of whole-body magnetic resonance using diffusion-weighted imaging with background suppression (WB-DWIBS) for detecting bone metastases compared with whole-body bone scintigraphy (WB-BS).Twenty-three patients with solid tumours underwent both WB-DWIBS imaging and WBBS. A nuclear medicine specialist interpreted WB-BS images and two blinded radiologists, first independently and then jointly, interpreted the WB-DWIBS images by completing a reading grid categorising the skeletal segments. Cohen's k statistic was used to determine interobserver agreement in reading the WB-DWIBS images and the agreement between WB-BS and WB-DWIBS. Sensitivity and specificity were calculated per patient and per lesion.Interobserver agreement in reading the WBDWIBS images was substantial or good, with κ=0.68. Analysis of agreement between the nuclear physician's and the radiologists' readings provided κ=0.87 [95% confidence interval (CI)=0.76-0.98)] Per-lesion analysis gave a sensitivity of 80% (95% CI=75-85) and a specificity of 98.2% (95% CI=96.5-99.8).We found a good level of interobserver agreement for the WB-DWIBS images and an excellent level of agreement in the subjective judgement of presence or absence of disease between WB-BS and WB-DWIBS after consensual double reading. WB-DWIBS has the same specificity as WB-BS in detecting bone metastases. The anatomical sites exhibiting the highest level of disagreement between WB-DWIBS and WB-BS are the pelvis, the coccyx, and the sternum, all sites at which detection with WB-BS has the greatest limitations.

Amyotrophic Lateral Sclerosis (ALS) is a devastating incurable disease. Stem-cell-based therapies represent a new possible strategy for ALS clinical research. The objectives of this Phase 1 clinical study were to assess the feasibility and toxicity of mesenchymal stem cell transplantation and to test the impact of a cell therapy in ALS patients. The trial was approved and monitored by the National Institute of Health and by the Ethics Committees of all participating Institutions. Autologous MSCs were isolated from bone marrow, expanded in vitro and analyzed according to GMP conditions. Expanded MSCs were suspended in the autologous cerebrospinal fluid (CSF) and directly transplanted into the spinal cord at a high thoracic level with a surgical procedure. Ten ALS patients were enrolled and regularly monitored before and after transplantation by clinical, psychological, neuroradiological and neurophysiological assessments. There was no immediate or delayed transplant-related toxicity. Clinical, laboratory, and radiographic evaluations of the patients showed no serious transplant-related adverse events. Magnetic resonance images (MRI) showed no structural changes (including tumor formation) in either the brain or the spinal cord. However the lack of post mortem material prevents any definitive conclusion about the vitality of the MSCs after transplantation. In conclusion, this study confirms that MSC transplantation into the spinal cord of ALS patients is safe and that MSCs might have a clinical use for future ALS cell based clinical trials. © 2009 Elsevier Inc.

Acquired copper deficiency constitutes an under-recognised cause of myelopathy. Aim of the study was to describe the clinical and imaging features at admission and after copper supplementation of a patient with acquired copper deficiency myeloneuropathy. A 73-year-old woman presented with anaemia and signs of posterior column dysfunction. Somatosensory evoked potentials showed impaired central pathway conduction. Serum copper and caeruloplasmin levels were low. Nerve conduction assessment revealed axonal polyneuropathy. Spinal magnetic resonance imaging (MRI) showed posterior column hyperintensity. Diffusion tensor imaging disclosed decreased fractional anisotropy (FA) corresponding to the hyperintensity. Copper supplementation normalised the haematological picture, whereas vibratory sensitivity was only slightly improved. Control MRI revealed a slight hyperintensity at C1–C2 level; FA values normalised. In conclusion, in acquired copper-deficiency-associated myelopathy, correction of blood and MRI alterations precedes that of neurological manifestations, which may remain suboptimal.

Objective To prospectively evaluate predictors of incomplete recovery after the first attacks in a cohort of patients with clinically isolated syndrome or relapsing—remitting multiple sclerosis. Methods Seventy-two consecutive patients recruited from January 2001 to December 2003, evaluated every six months or at any relapse up to 31 July 2005. Relapse intervals were calculated from the date of onset, nadir, onset of improvement and maximum improvement. Predictive factors analysed were relapse-related (age at relapse onset, season and severity of the relapse, type of symptoms, speed of onset, plateau and total duration, number of affected Functional systems, preceding infections) and individual-related (gender, age at first attack, season of birth and first attack, characteristics of first brain MRI and cerebrospinal fluid oligoclonal bands, Link Index, IgG). Results We counted 209 attacks: 44 (21%) left mild sequelae, and 27 (13%) severe. The highest probability of sequelae was associated with sphincteric symptoms (9/20; 45%), followed by sensitive (38/113; 34%), motor (20/84; 24%), visual (13/61; 21%), cerebellar (4/24; 17%), brainstem (5/44; 11%) and others (0/6) ( P 0.005). Four variables were still relevant to predict sequelae after multivariate analysis: mild, moderate or severe relapses versus very mild (Odds ratio = 17.2, 95% confidence limits = 2.2—136.4), intermediate or long relapses versus short (3.2, 1.5—6.9), age ≥ 30 at relapse onset (2.9, 1.5—5.7) and bi-polysymptomatic versus monosymptomatic (2.2, 1.1—4.3). Conclusions Factors predicting incomplete recovery are more closely linked to the characteristics of the single relapse (extension and duration of tissue damage) than to the patient's genetic and environmental background. Multiple Sclerosis 2008; 14: 485—493. http://msj.sagepub.com

Purpose To find the optimal contrast agent dilution to maximize signal intensity (SI), signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) in shoulder MR arthrography using MR systems operating at different magnetic field strengths. Materials and Methods Autoptic human glenohumeral ligaments were inserted in eight egg-shaped 20-mL phantoms filled with saline and gadolinium diethylenetriaminepentaacetic acid bismethylamide (Gd-DTPA-BMA) in different dilutions of 0.5, 1, 2, 2.5, 5, 12.5, 50 mmol/liter, to simulate the shoulder articular capsule. These phantoms were inserted inside two plastic 240-mL phantoms filled with water. MRI was performed on 0.2-, 0.5-, 1.0-, 1.5-, and 3.0-T MR systems using a three-dimensional gradient echo (GRE)-T1-weighted pulse sequence. SI, SNR, and CNR were determined. Results Peak SI and SNR were found at 5 mmol/liter, with the exception of the 0.2-T scanner, where the maximum was at 2 mmol/liter. Peak CNR was observed at 1 mmol/liter for the 3-T scanner, at 2 mmol/liter for the 0.2- and 0.5-T scanners, and at 5 mmol/liter for the remaining scanners. Conclusion The optimal SI and SNR are provided by 5 mmol/liter contrast agent dilution. Peak CNR was found in a range between 1 and 5 mmol/liter dilutions, depending on the strength of the magnetic field. J. Magn. Reson. Imaging 2007. © 2006 Wiley-Liss, Inc.

The presence of a static magnetic field (Bo), a radiofrequency field (RF), a dynamic gradient which varies in time and loud noises during an MR examination could increase patient risk. Specifically, a magnetic field could interfere with ferromagnetic material leading to one of the following five dangerous interactions: 1) projectile effect, 2) twisting, 3) burning, 4) artefacts and 5) device malfunction. The projectile effect is when an object is attracted by the magnet with the risk, as reported in literature, of hitting the patient, operators and/or the instrument. Objects which typically can undergo this effect are oxygen and helium cylinders, IV stands, cleaning trolleys, chairs, lamp holders, scissors, forceps, clampers, traction weights, monitoring instruments, and especially metallic splinters within the patient. Twisting (torsion) typically occurs with cerebral vascular clamps and cochlear implants. If parts of implants are involved a malfunction may result. Burns can be caused when electrically conductive material is introduced within the magnet, for example, ECG electrodes, monitoring cables and coils which are in contact with the patient’s skin, as well as tattoos and eye-liners that contain iron-oxides. Artefacts can be induced by RF emission of implanted devices which can be mistaken for noise of the receiving coil. Implanted devices can induce signal voids which mask or simulate pathologies. Electrical or mechanical malfunction of implanted devices includes pacemakers which can stimulate inappropriately or at an elevated frequency yielding a distorted ECG with altered T-waves. The risk for patients can be reduced by specific educational programs within individual radiology departments which include other specializations and external referring physicians with the aim of developing a standardized safety protocol.

Percutaneous vertebroplasty (PVP), first described by Hervè Deramond in 1984, is an interventional procedure for the treatment of aggressive vertebral angioma. The aim of this study was to evaluate magnetic resonance imaging (MRI) patterns in the affected vertebrae before and after vertebroplasty by determining changes in signal intensity and size and distribution of bone cement within the vertebra at follow-up carried out at 1 week, 6 months and 12 months.Fourteen patients were examined using MRI, for a total of 41 treated vertebrae; MRI was performed with a 0.5-Tesla (T) superconductive magnet (SIGNA GE).MRI patterns following vertebroplasty are mainly characterised by the signal produced by the areas surrounding the cement and by the cement itself. There is little effect on the size of the treated vertebra. Acrylic cement appears as an intraspongy focal area of T1 and T2 hypointensity that is mostly oval (34%) or rounded (26.8%); this appearance tends to become stable 6 months after treatment. The area surrounding the cement appears hypointense on T1 and hyperintense on T2, a likely expression of bone marrow oedema; this signal alteration tends to disappear gradually.In pre- and post-vertebroplasty imaging, MRI is regarded as the reference standard for correct evaluation of both container and content. Awareness of cement changes over time and of the reaction of the surrounding bone tissue is crucial for correct assessment of post-vertebroplasty images.

Purpose: To assess whether magnetic resonance imaging (MRI) is useful in predicting which patients affected by stress urinary incontinence (SUI) will benefit from a new anti-incontinence therapy named adjustable continence therapy (ACT™). Methods: We prospectively evaluated a group of 25 female patients affected by SUI and treated with ACT. Before and after treatment all patients were clinically assessed by physical examination, urodynamic evaluation and pad test. All patients had an MR examination before and 3 and 12 months after ACT surgery to compare the position of the bladder neck in relation to the pubococcygeal line (PCL). Results: 21/25 (84%) patients were improved; 16 (64%) of these patients were dry and 5 (20%) significantly improved. Before treatment, the mean PCL distance was significantly different (p < 0.01) between the responsive and the non-responsive groups. Conclusions: MRI provides an effective radiological method to predict the efficacy of the ACT.

Objective To assess the efficacy of single, double and triple doses of 1M gadolinium in the magnetic resonance (MR) evaluation of multiple sclerosis (MS) lesions in order to establish the best trade-off in terms of dose and number of injections. Materials and methods Twenty-three patients with relapsing remitting or secondary progressive MS underwent MR scans of the brain, spine or both. Signal intensity, the number of enhancing lesions and the areas of MS plaque were measured in T1-weighted images before and after single, double or triple doses of contrast medium. Wilcoxon's two-sample test and the Mann–Whitney U -test were used to evaluate the differences between the groups, and between doses in the same patient. Results There was no significant difference in area signal intensity or the number of enhancing lesions between the group examined after a single injection of double-dose (DD) contrast medium and the group examined after multiple injections of a triple dose (TD). The difference in the areas of enhancement and signal intensity between a single dose (SD) and TD significantly increased after the second bolus. Conclusion Gadolinium injections in MS patients can be optimised by giving a single DD bolus, which leads to the same results as a TD administered as two boli.

Purpose. Percutaneous vertebroplasty (PVP), first described by Herve Deramond in 1984, is an interventional procedure for the treatment of aggressive vertebral angioma. The aim of this study was to evaluate magnetic resonance imaging (MRI) patterns in the affected vertebrae before and after vertebroplasty by determining changes in signal intensity and size and distribution of bone cement within the vertebra at follow-up carried out at 1 week, 6 months and 12 months.

Background The purpose of this study was to compare virtual MR arthroscopic reconstructions with arthroscopic images in patients affected by shoulder joint instability. MR arthrography (MR-AR) of the shoulder is now a well-assessed technique, based on the injection of a contrast medium solution, which fills the articular space and finds its way between the rotator cuff (RC) and the glenohumeral ligaments. In patients with glenolabral pathology, we used an additional sequence that provided virtual arthroscopy (VA) post-processed views, which completed the MR evaluation of shoulder pathology. Materials and methods We enrolled 36 patients, from whom MR arthrographic sequence data (SE T1w and GRE T1 FAT SAT) were obtained using a GE 0.5 T Signa—before any surgical or arthroscopic planned treatment; the protocol included a supplemental 3D, spoiled GE T1w positioned in the coronal plane. Dedicated software loaded on a work-station was used to elaborate VAs. Two radiologists evaluated, on a semiquantitative scale, the visibility of the principal anatomic structures, and then, in consensus, the pathology emerging from the VA images. Results These images were reconstructed in all patients, except one. The visualization of all anatomical structures was acceptable. VA and MR arthrographic images were fairly concordant with intraoperative findings. Conclusions Although in our pilot study the VA findings did not change the surgical planning, the results showed concordance with the surgical or arthroscopic images.