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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.

Aims and objectives Methods and materials Results Conclusion Personal information References, Aims and objectives: The thyroglossal duct is a narrow tubular structure connecting the primordium of the thyroid gland to the tongue in the midline. If the duct does not involute at 8-10th weeks of gestation, secretion for infection or inflammation causes a...

BACKGROUND AND PURPOSE: We present functional connectivity (FC) changes found in the very first patients treated with the first Italian installation of a trans-cranial MRI-guided Focused Ultrasound Surgery (tcMRgFUS) certified system for functional neurosurgery. TcMRgFUS is a promising new technique for non-invasive treatment of neurologic disorders such as Essential Tremor, tremor associated to Parkinson's Disease and Neuropathic Pain. TcMRgFUS is able to focally target and destroy specific regions in the brain through intact skull, by using a high intensity focused ultrasound beam. Resting state functional Magnetic Resonance Imaging (RS-fMRI) analyses focuses on spontaneous low frequency fluctuations (< 0.1 Hz) in the BOLD signal and investigates synchronous activations between spatially independent brain regions (FC), occurring in the absence of a task or stimulus. METHOD AND MATERIALS: Patient enrollment was based on indication for functional neurosurgery and evidence of medication-refractory disease; we treated three patients, respectively affected by: neuropathic pain, intentional tremor due to ischemic lesion and essential tremor. A detailed medical history was collected together with a complete clinical examination and a neurophysiological assessment. TcMRgFUS treatments were performed by a neurosurgeon with proven experience in functional neurosurgery, and an experienced neuroradiologist, optimizing treatment parameters case by case. All patients underwent a 10’ RS-fMRI session immediately before and two days after the treatment. Functional connectivity data was analyzed by the use of the MELODIC tool from FMRIB Software Library (FSL) in a single-subject fashion, comparing post- and pre-treatment data. RESULTS: All the patients experienced an important and almost immediate improvement of their symptoms, with a complete recovery of the tremor and a partial pain relief in the patient with neuropathic pain. No adverse events were reported. We found modifications of FC within sensory-motor networks in all patients. CONCLUSION AND DISCUSSION: Although this is a very preliminary experience and our sample is very small, the FC changes we found pave the way to the use of RS-fMRI as a powerful tool to be correlated to clinical-neurologic outcomes.

Provide basic key-points to evaluate placement of umbilical venous catheters (UVC) using a simplified flow-chart in resident radiologist.

Purpose: To evaluate early tumour control capabilities of Stereotactic Radiosurgery (SRS) in the treatment of brain metastasis and the role of follow-up MR imaging. Methods and Materials: MR imaging of 54 metastases in 31 patients treated with SRS who underwent follow-up MR imaging within 12 months were retrospectively reviewed. Tumours were characterized as either enlarged (>20% volume increase), stable (follow-up volume ±20% of the initial volume), or decreased (> 0% volume decrease). Results: Within the first 6 weeks following SRS a decrease was observed in 25 (52%) of the tumours in the extent of 63% in size. Tumour reduction varied according to histopathological subtype with 38% of non-small cell lung carcinomas, 41% of breast carcinomas, 14% renal cell carcinoma and 8% of melanomas. At 9 weeks, 7 out of the 25 lesions had a transient tumour volume increase followed by tumour regression at 12 weeks. At 12 months 19 (37%) of lesions increased in volume in the extent of 41% in size. There was a significant higher tumour reduction in those carcinoma types that are considered as radiation sensitive. The best timing for follow-up imaging is at 6, 9 and 12 weeks to provide clinicians useful information. Conclusion: Stereotactic radiosurgery provide volume reduction in many brain metastases and it may be used alone or before whole brain radiation therapy to early tumour control. Follow-up MR imaging provide clinicians useful patient information aimed to make treatment decisions.

Purpose: Due to admitted limits of autopsy-based studies in the diagnosis of drowning, virtopsy is considered the new imaging horizon in these post-mortem studies. The aim of our study was to evaluate the role of virtopsy performed through computed tomography (CT) in the forensic diagnosis of drowning. Materials and methods: We retrospectively examined the CT data of four cadavers recovered from sea water and suspected to have died by drowning. Each patient underwent a full-body post-mortem CT scan, and then a traditional autopsy. Conclusion: To date, there are no autopsy findings pathognomonic of drowning. This study proves that virtopsy is a useful tool in the diagnosis of drowning in that it allows us to understand if the victim was alive or dead when he entered the water and if the cause of death was drowning. Results: All the cadavers showed fluid in the airways and patchy ground-glass opacities in the lung. Only one patient had no fluid in the digestive tract; this patient had a left parietal bone fracture with a large gap and other multiple bone fractures (nose, clavicle, first rib and patella). One of the three patients who had fluid in the digestive tract had no fluid in the paranasal sinuses. This latter patient showed cerebral oedema with subarachnoid and intraventricular haemorrhage, multiple bone fractures (orbital floor, ribs, sacrum and acetabular edge) and air in the heart, in the aorta and in bowel loops. © 2014, Italian Society of Medical Radiology.

1. Purpose To supply an useful learning tool aimed to interactively display on mobile devices normal anatomy and variants of the nose and paranasal sinuses as seen on CBCT images. 2. Methods and Materials Images Images of the nose and paranasal sinuses were derived by a study series acquired by a CBCT device. CBCT studies of the paranasal sinuses were acquired in patients referred for nasal obstruction or sinusitis with the following parameters: 90 kVp, 12.5 mA, 20 s rotation time, FOV 13 x 14.5 cm, 0.25 x 0.25 x 0.25 mm voxel size. Software The application has been developed for iOS based mobile devices through the platform XCode provided by Apple®, and it is developed using the Objective-C programming language. The application has been configured as Master-Detail. This configuration splits the mobile device display in two panels. The left panel displays a list of the interesting items, while the right panel shows the relative details. Touching an item from the menu on the left panel, the textual description is shown on the same side, while the panel on the right will show the relative image. The application allows interactively navigation through normal anatomy and variants of the nose and paranasal sinuses, as represented on CBCT images in axial, sagittal and coronal planes. Cross-reference images to localize the same anatomic structures on different section planes are available. The navigation is intuitive, with multiple shortcuts. Different labels have been proposed in accordance with the specific anatomic lessic of the district and current literature references. High image quality with a zooming tool are available. 4. Conclusion An App for IOs devices was developed, that can represent an useful educational tool for medical students, residents and continuous medical education in radiology and other medical specialties dealing with nose and paranasal sinuses. This interactive atlas based on CBCT images could be also an useful option to be implemented on CBCT softwares

Learning objectives Background Findings and procedure details Conclusion Personal information References, Learning objectives: The aim of our work is to discuss the clinical and technical eligibility for MRgFUS of women with symptomatic uterine fibroids emphasizing the lack of knowledge of this technique among both patients and...

Aims and objectives Methods and materials Results Conclusion Personal information References, Aims and objectives: In the last years, the number of MRI scans has more than tripled[1]and this resulted in an unavoidable rise of incidentally detected findings[2-6]. According to a study by Orme et al.[7], a minimum of one incidental finding was present in 39.8% of...

L'EIC è caratterizzata dalla presenza di lesioni parenchimali irreversibili, risultato di una lunga esposizione a regimi pressori patologici specie in pazienti che non seguono o non rispondono alle comuni terapie mediche. Si riscontrano quali reperti tipici multipli esiti gliotici, leucoaraiosi e multiple lesioni lacunari con predilezione per le localizzazioni profonde ai nuclei lenticolari, ai talami e al ponte. Più raramente possono evidenziarsi minuti foci emorragici parenchimali, più frequentemente localizzati nei gangli della base ma anche nel ponte e nel cervelletto, che in alcuni casi possono rappresentare la manifestazione principale della patologia: questi microsanguinamenti, visibili incostantemente in TC, sono classicamente ben individuabili in RM come aree di netta ipointensità di segnale in GRE (Gradient Recalled Echo) T2* pesate. Scopo del nostro lavoro è quello di presentare due casi in cui l'EIC si manifesta prevalentemente con un quadro micro-emorragico confrontando la sensibilità delle convenzionali sequenze GRE T2* pesate con sequenze sensibili al fenomeno della suscettività magnetica (Susceptibility-Weighted Imaging, SWI) di più recente introduzione nella routine diagnostica.

Short Summary: ONJ is associated with bisphosphonates, and recently with antiangiogenic drugs. Another cause is radiotherapy. Few papers have previously investigated the value of CBCT in the diagnosis of ONJ. Purpose/Objectives: To describe the CBCT findings in the diagnosis of osteonecrosis of the jaws (ONJ) according to a new staging system of ONJ. Methods and Materials: 9 patients (5 women, 4 men, 54-76 yrs.) affected by ONJ were studied with a CBCT device (90 kV, 12.5 mA, 0.25 mm voxel size) in 2012-2013. 7/9 patients were treated with bisphosphonates (5 for bone metastasis, 2 for osteoporosis), 1/9 patient was treated with an antiangiogenic drug, 1/9 patient received radiotherapy. Patients were divided in 3 stages, according to a new clinical-radiologic classification of ONJ, made by SICMF (Italian Society of Maxillo-Facial Surgery) and SIPMO (Italian Society of Oral Medicine), that gives more prominence to the radiologic findings and includes 3 stages: stage 1 focal ONJ, a) symptomatic, b) asymptomatic; stage 2 diffuse ONJ, a) symptomatic, b) asymptomatic; stage 3 complicated ONJ. Axial, panoramic, cross sectional, multiplanar and 3D reformations were analysed. Results: Radiologic findings of ONJ were found in maxilla (7/9 patients) and mandible (7/9 patients). Patients were staged as follows: 1/9 stage 1b), 1/9 stage 2a), 4/9 stage 2b), and 3/9 stage 3. CBCT findings varied from simple osteosclerosis in stage 1b), to multifragmentary fracture, extraoral fistula, and fistula between oral cavity and maxillary sinus or nasal cavity in stage 3 patients, passing through osteonecrosis and bone sequestrum in 7 patients in stage 2-3. Conclusion: CBCT is a valuable tool in the radiologic assessment of ONJ and proved useful in this new SICMF-SIPMO staging system. Keywords: Staging, jaws, osteonecrosis, CBCT

PURPOSE: We present a case of intracranical hemangiopericytoma (HPC) in a patient with migraine (male, 49 years old), who also presented mental confusion and partial left sensorimotor syndrome. We will also provide some elements regarding the international classification of this rare and highly vascularized mesenchymal tumor, and will consider possible differential diagnosis with other more common extra-axial masses. METHODS: After a preliminary examination in ER, patient underwent to head CT examination and was then transferred to the neurosurgical unit. The day after a brain MR examination was performed using advanced techniques too (PWI, and MRS); before surgery also functional MR imaging (fMRI) and CTA where performed. RESULTS: CT scans showed a left frontoparietal expansive lesion, most likely of extra-axial nature, with heterogeneous characteristics and polilobulated margins. There was a severe mass effect on adjacent parenchymal structures and heavy involvement on the adjacent skull bone. MR examination with conventional sequences confirmed the extra-axial nature of the lesion, which appeared to be highly vascularized as later confirmed by CTA. The analysis of lesions perfusion by DSCE-PWI (EPI-T2*w) confirmed these findings, showing permeability curves compatible with a highly vascularized lesion (high rCBV and rCBF values) without hematoencephalic barrier. Spectroscopy examination showed an increased Cho peak, compatible with a high cell proliferation with a lipid/lactate peak into the intralesional areas of necrosis. Diagnostic hypothesis of HPC was placed. The fMRI presurgical examination allowed to identify language and motor areas that were all considerably dislocated. CONCLUSIONS: Pathologic examination confirmed diagnosis of anaplastic HPC (WHO III), a tumor originating from malignant transformation of microcircle Zimmerman’s pericytes, a rare tumor of the central nervous system (0,4% of all primary tumors, previously classified as angioblastic meningioma). Anaplastic HPS (AHPC) is usually characterized by a more lobulated shape, substantial bleeding, necrosis or cystic areas, marked peritumoral edema and signs of cranial table erosion, while the typical “dural tail” sign is more frequent in the non-anaplastic types (WHO II).

SCOPO DEL LAVORO: presentiamo un caso di Sclerosi Tuberosa (Tuberous sclerosis complex, TSC; anche nota come Sindrome di Bourneville-Pringle) diagnosticato tardivamente grazie al sospetto posto dalle indagini neuroradiologiche eseguite in una paziente di 40 anni con in anamnesi ritardo mentale, crisi epilettiche e disturbi del visus.MATERIALI E METODI: la paziente si presenza alla nostra attenzione per un episodio di disorientamento e confusione mentale; dopo una prima valutazione in PS veniva eseguita una TC dell’encefalo in tecnica sequenziale (Siemens SOMATON AS+, 128 strati) e trasferita presso l’U.O.C. di Neurologia. In seguito, per una migliore caratterizzazione dei reperti descritti in TC, veniva eseguito un approfondimento diagnostico mediante esame RM con apparecchiatura da 1,5T (GE Signa HDxt) in tecnica SE, FSE, FLAIR, GE e DWI , completato dopo somministrazione ev di mezzo di contrasto (mdc) paramagnetico. RISULTATI: lo studio TC ha evidenziato la presenza di una diffusa calcificazione delle girazioni occipitali di sinistra che si estende a coinvolgere la sottostante sostanza bianca ed altre due minute lesioni calciche rispettivamente a destra in prossimità della scissura calcarina in sede verosimilmente corticale e l’altra in sede endoventricolare sinistra (in prossimità del forame di Monroe). Lo studio RM in seguito acquisito dimostrava inoltre la presenza di multiple aree di alterazione di segnale nelle sequenze a lungo TR, bilateralmente in corrispondenza delle circonvoluzioni frontali superiori e nei giri precentrali, a destra nel giro post-centrale, nella circonvoluzione frontale media, in sede parietale posteriore ed occipitale ed infine, a sinistra, in sede temporale posteriore. Dopo somministrazione ev di mdc si apprezzava enhancement del millimetrico nodulo subependimale in prossimità del forame di Monroe di sinistra e parziale ed irregolare enhancement della diffusa area calcica cortico-sottocorticale occipitale sinistra. CONCLUSIONI: i reperti evidenziati alle neuroimmagini con distribuzione radiale cortico-sottocorticale sono stati interpretati come “tuberi corticali”; il nodulo in prossimità del forame di Monroe di sinistra come un piccolo astrocitoma subependimale a cellule giganti; l’area calcica occipitale sinistra, reperto certamente inusuale, si è ipotizzato poter essere riferibile ad un’area di degenerazione calcica amartomatosa non potendo tuttavia escludere altre ipotesi diagnostiche. Tali reperti hanno fatto porre l’ipotesi diagnostica di TSC; ipotesi diagnostica successivamente avvalorata dalla valutazione dermatologica (tipiche macchie cutanee ipomelanotiche con angiofibromi facciali multipli). In atto si attende responso dell’analisi genetica per mutazioni dei geni TSC1/TSC2.

Rarely a blowout orbital fracture is related to sneezing in patients with no history of trauma or sinus surgery. A case of barotraumatic, pure and isolated blowout fracture of the right orbit after sneezing diagnosed by CBCT is reported. A forty-year-old man complained sudden right diplopia after vigorous sneezing. On MRI a reduced size and an altered shape of the right maxillary sinus, a slightly increased vertical diameter of the right orbit, a round shape of the inferior rectus muscle on coronal sections, and a right maxillary haemosinus were observed. A strong peripheral enhancement of the maxillary sinus wall was evident. One week after the patient was submitted to a maxillofacial CBCT (90 kVp, 13 mA, 20 s rotation time, FOV 13 x 14.5 cm, 0.25 x 0.25 mm pixel size) at our Institution. A blowout fracture of the orbital floor and lateral orbital wall with an intact orbital rim and a maxillary sinus effusion were detected. The hydraulic theory can explain how hydraulic forces generated during nose blowing or sneezing causes a blowout fracture of the orbital floor. Incarceration of extraocular muscles within an orbital fracture is the most commonly reported cause for diplopia. However it was postulated that traumatic haemorrhage causes swelling of the posterior inferior orbital fat, producing strain on inferior rectus and inferior oblique muscles with consequent diplopia. Radiologists and more generally doctors should be aware that among the causes of sudden diplopia can be also included a barotraumatic blowout fracture of the orbit after sneezing.

PURPOSE: There have been many reports describing adrenal myelolipoma but there have been only few reports of extraadrenal myelolipoma. We describe a case of an elderly woman with lower back pain due to age-related spondyloarthrosis and mild discopathy with a presacral myelolipoma as incidental finding. We also discuss about common and uncommon imaging findings of other presacral masses. METHODS: A 74 years-old woman came to our observation to perform an MRI of the lumbar spine for typical lumbar back pain. MR imaging revealed, in addition to the signs of mild scoliosis and spondylo-disc-arthrosis, a presacral mass showing heterogeneously high signal in all sequences and almost completely suppressed on inversion recovery sequences for fat tissue and not showing significant enhancement after i.v. administration of contrast medium. CT imaging confirmed the fatty nature of the lesion without any sign of bone involvement. RESULTS: CT and MR imaging findings were most consistent with a diagnosis of a rare presacral myelolipoma. Our hypothesis was confirmed at histopathologic analysis which showed a mixture characterized predominantly by mature adipocytes and hematopoietic cells including erythroid, myeloid, and megakaryocytic elements without mesenchimal tissue elements. CONCLUSIONS: We have reported a case of one of the rarest presacral masses and we have emphasized the role of imaging in the differential diagnosis of other presacral masses inclunding liposarcomas, teratomas, dermoids, epidermoids, chordomas, schwannomas and anterior sacral meningoceles.

SCOPO Presentiamo un caso di encefalite virale con lesione reversibile dello splenio del corpo calloso (SCC) in un ragazzo di 16 anni con mononucleosi infettiva da coinfezione Epstein-Barr Virus (EBV) e Citomegalovirus (CMV). MATERIALI E METODI Il paziente, a causa della comparsa improvvisa di stato confusionale, irrigidimento e movimenti involontari alternati a tremori in corso di mononucleosi infettiva, giungeva in PS, dove eseguiva una TC encefalo (Siemens SOMATOM Definition AS+ - 128 strati) in condizioni di base ed in tecnica sequenziale, che non evidenziava reperti significativi. Veniva quindi ricoverato con il sospetto di encefalite virale e, il giorno successivo, veniva sottoposto ad un approfondimento diagnostico mediante RM encefalo con apparecchiatura da 1,5 Tesla (GE Signa HDxt), in tecnica FSE, FLAIR e DWI sui piani assiale, sagittale e coronale prima e dopo mdc e.v. Si intraprendeva terapia antivirale, cortisonica ed antibiotica. Nelle giornate successive le condizioni generali del paziente miglioravano gradualmente. La comparsa di anticorpi anti virus capsidico di classe IgM (VCA IgM) e la presenza di DNA di CMV (CMV-DNA 250 copie/ml) consentivano di formulare la diagnosi di mononucleosi infettiva da coinfezione EBV-CMV. Un nuovo controllo RM veniva eseguito a quattro giorni di distanza dal precedente. RISULTATI La prima RM encefalo evidenziava la presenza di una lesione ovalariforme a carico dello SCC, modicamente rigonfio, caratterizzata da iperintensità di segnale nelle ponderazioni a lungo TR, da restrizione della diffusività dell’acqua in DWI, in assenza di impregnazione post-contrastografica. Nella seconda RM encefalo lo SCC non appariva più rigonfio e la lesione precedentemente descritta non era più apprezzabile. CONCLUSIONI Il quadro neuroradiologico e clinico-laboratoristico del paziente ci permettono di classificare il nostro caso tra le lesioni reversibili dello SCC. Tali lesioni sono state già descritte in letteratura ma non ci risulta sia mai stato presentato un caso da coinfezione EBV-CMV. Svariate sono infatti le condizioni che possono causare lesioni reversibili dello SCC; le più frequenti sono rappresentate da encefaliti virali, tossicità o rapida sospensione dei farmaci antiepilettici ed encefalopatia ipoglicemica. L’iperintensità di segnale in DWI, correlata a restrizione della diffusività delle molecole d’acqua nelle mappe ADC, rappresenta il reperto di semeiotica RM più significativo di tali lesioni ed è verosimilmente riconducibile, in accordo con quanto riportato in letteratura, ad una condizione di edema eccitotossico intramielinico da aumento delle concentrazioni di glutammato nello spazio extracellulare, sebbene non possano essere del tutto escluse altre ipotesi etiopatogenetiche.

SCOPO DEL LAVORO: Lo scopo di questo lavoro è documentare un caso di Amnesia Globale Transitoria (Transient Global Amnesia, TGA) in un paziente emicranico di sesso maschile di 52 anni con anamnesi negativa per epilessia, disturbi psichiatrici, traumi ed abusi di sostanze. Saranno inoltre effettuati dei cenni sull’epidemiologia e i meccanismi fisiopatologici oggi più accreditati nella letteratura scientifica più recente di questa controversa sindrome neurologica. MATERIALI E METODI: Poco dopo un forte stress emotivo il paziente non ricordava cosa avesse fatto durante il giorno e ripeteva incessantemente le stesse domande a cui erano comunque state date più volte delle risposte dai colleghi presenti sul luogo di lavoro. L’esame obiettivo neurologico ha evidenziato un’amnesia anterograda e retrograda senza altri segni e sintomi neurologici di accompagnamento; l’elettroencefalogramma inoltre era negativo. Il caratteristico quadro clinico, risoltosi completamente entro 24 ore, ha fatto porre l’ipotesi diagnostica di TGA: sindrome neurologica benigna descritta per la prima volta da Bender e, successivamente, da Guyotat e Courjon. Dopo una prima valutazione in PS il paziente è stato sottoposto a TC dell’encefalo (Siemens SOMATOM Definition AS+ - 128 strati) e, successivamente, ad esame RM con apparecchiatura da 1,5T (GE Signa HDxt) mediante sequenze FSE, FLAIR, GRE e DWI effettuando anche una valutazione dopo somministrazione di mdc ev. RISULTATI: Lo studio TC e le sequenze convenzionali dello studio RM non hanno evidenziato alterazioni di rilievo ad eccezione di pochi esiti gliotici di pregressi microinsulti vascolari in sede giunzionale frontale e parietale bilaterale compatibili con la storia clinica del paziente. Nelle immagini pesate in diffusione si sono tuttavia apprezzati due millimetrici spot iperintensi in sede ippocampale destra di verosimile restrizione della diffusione delle molecole d’acqua. Il disturbo mnesico si è risolto nell’arco delle 24 ore successive e, ad un nuovo controllo RM effettuato a 2 settimane di distanza dall’episodio acuto, si è documentata la scomparsa di tali reperti. CONCLUSIONI: L’utilizzo di sequenze pesate in diffusione (Diffusion Weighted Imaging, DWI) specie utilizzando elevati valori di b (b=2000s/mm2) e spessori di acquisizione sottili (

Learning objectives Background Imaging findings OR Procedure details Conclusion References Personal Information, Learning objectives: Paleoanthropology studies the development of ancient cultures also by morphometric evaluation of cadaveric specimens, often using advanced diagnostic imaging. In fact, modern technologies allow, often with minimally invasive approach, an accurate...

SCOPO Presentiamo il caso di una paziente anziana (74aa) con tipica sintomatologia da artrosi e discopatia lombo-sacrale (rigidità e dolore alla regione lombare con tipica irradiazione ai glutei ed alla superficie posteriore di entrambi gli arti inferiori, con associata sensazione di intorpidimento) e segni di radicolopatia L4-L5-S1 all’esame obiettivo neurologico, che si presenta alla nostra attenzione per eseguire un esame RM del rachide lombo-sacrale. MATERIALI E METODI L’esame RM è stato eseguito in condizioni di base con sequenze TSE-T1, TSE-T2 e STIR-T2 secondo piani sagittali ed assiali (GE Signa HDxt 1,5T). E’ stata inoltre effettuata un’integrazione RM dopo somministrazione di mdc paramagnetico ev con sequenze con soppressione del segnale proveniente dal grasso secondo piani assiali, sagittali e coronali. Per un’ottimale valutazione delle strutture ossee la paziente è stata in seguito sottoposta ad esame TC mirato in tecnica spirale (GE BrightSpeed 16). RISULTATI L'indagine RM ha evidenziato, oltre un quadro di spondilo-disco-artrosi e segni di lieve rotoscoliosi, la presenza di una massa presacrale extraperitoneale, a margini netti. All'indagine RM in condizioni di base la lesione mostrava segnale elevato in tutte le sequenze con una pressoché completa soppressione del segnale FAT-SAT e STIR. La somministrazione di mdc paramagnetico ev evidenziava un minimo enhancement esclusivamente a carico delle formazioni nodulari solide intralesionali non del tutto soppresse in FAT-SAT e STIR. All’integrazione TC si confermava la natura prevalentemente adiposa della lesione (-20/-30 HU) che non determinava sostanziali modificazioni del profilo osseo della contigua superficie dell’osso sacro. CONCLUSIONI La caratteristica semeiotica neuroradiologica della lesione ha fatto porre l’ipotesi diagnostica di una rara localizzazione extrasurrenalica di mielolipoma (tumore benigno contenente tessuto adiposo maturo e cellule del sistema ematopoietico, generalmente localizzato in corrispondenza delle ghiandole surrenaliche). Ipotesi successivamente confermata all’analisi anatomo-patologica della lesione che è stata asportata in considerazione della possibile insorgenza di complicanze emorragiche non infrequenti nelle localizzazioni tipiche (surrenaliche) ma ad oggi mai documentate nel caso di localizzazioni pre-sacrali. Saranno brevemente discusse le possibili lesioni a localizzazione presacrale e sviluppo extraperitoneale che possono entrare in diagnosi differenziale (liposarcomi, cordomi sacrococcigei, teratomi, meningoceli sacrali anteriori e schwannomi pelvici).

SCOPO DEL LAVORO: Lo scopo di questo lavoro è documentare un caso di meningocele sacrale anteriore (Anterior Sacral Meningocele, ASM) rara forma di disrafismo spinale, diagnosticato in una giovane di 13 anni con riscontro ecografico di formazione cistica di verosimile pertinenza annessiale dopo visita Specialistica Ginecologica. La paziente si presenta con una clinica caratterizzata da: dolore pelvico, costipazione e cistiti ricorrenti. Sarà inoltre fatto un breve excursus sulle possibili diagnosi differenziali con altre masse pelviche a sviluppo presacrale. MATERIALI E METODI: A seguito di consulenza ginecologica, la paziente è stata sottoposta ad una ecografia transaddominale, che ha evidenziato la presenza in sede pelvica di una formazione anecogena, a margini regolari, del diametro massimo di 6 cm circa. Il caratteristico aspetto ecografico ha fatto porre l'ipotesi diagnostica di espanso cistico di pertinenza annessiale. La paziente, tuttavia, per una migliore caratterizzazione del reperto ecografico, ha effettuato esame RM con apparecchiatura da 1,5T (GE Signa HDxt), mediante sequenze TSE T1 e T2 pesate, nei piani assiale, coronale e sagittale. RISULTATI: Lo studio RM ha evidenziato, in sede pelvica mediana-paramediana destra, una formazione irregolarmente ovalare, extraperitoneale, con segnale simil liquorale in tutte le sequenze. Tale espanso risultava in continuità con il sacco midollare, attraverso un difetto osseo del profilo anteriore dei metameri sacrali del tratto S3-S4, ed era responsabile di netta dislocazione del retto e dell'utero. CONCLUSIONI: La RM rappresenta certamente la metodica di scelta per un'ottimale caratterizzazione delle masse pelviche di n.d.d. L'ASM può, specie con metodiche di I livello, essere misdiagnosticato come una massa di pertinenza annessiale. La RM, grazie all'elevata risoluzione di contrasto e alla multiplanarietà, ha inoltre elevata accuratezza nella diagnosi differenziale delle altre formazioni a possibile sviluppo presacrale (cisti di Tarlov, tumori della linea germinale, cordomi sacrococcigei, liposarcomi, schwannomi pelvici).

SCOPO DEL LAVORO Valutare l’accuratezza delle immagini T2-FLAIR e DWI nello studio delle lesioni caratteristiche dell’Encefalopatia di Wernicke. MATERIALI E METODI Studio effettuato su donna di 56 anni, affetta da Encefalopatia di Wernicke non alcool-correlata. Nel Dicembre 2011 la paziente è stata sottoposta ad esame RM, utilizzando un tomografo operante a 1,5 T con acquisizione di scansioni sui piani assiale, sagittale e coronale in tecnica Spin-Echo (SE), Fast Spin-Echo (FSE), Fluid Attenuated Inversion Recovery (FLAIR) e Diffusion Weighted Imaging (DWI), con sequenze T1 e T2 pesate. L’esame è stato completato dopo infusione e.v. di m.d.c. paramagnetico. L’indagine mostrava la presenza, nelle sequenze T2 e FLAIR, di una diffusa iperintensità a carico della regione talamica mediale bilaterale, lungo le pareti del terzo ventricolo, in regione periacqueduttale e nel tetto del mesencefalo, con lieve enhancement dopo somministrazione di contrasto; coesisteva, nelle regioni sopra descritte una lieve restrizione della diffusività dell'acqua in DWI, confermata poi dalle mappe ADC. Le successive indagini RM, effettuate – dopo terapia con Tiamina – rispettivamente a Gennaio e Luglio 2012, evidenziano la totale scomparsa della diffusa iperintensità nelle sequenze a TR lungo ed al bilancio DWI. RISULTATI Le indagini RM hanno dimostrato patterns caratteristici dell’Encefalopatia di Wernicke non alcol-correlata, in cui le lesioni sono associate alla carenza di Tiamina, che causa un deficit energetico, provocando l’alterazione dei gradienti osmotici transmembrana ed un susseguente edema citotossico e vasogenico, segnalato da un’iperintensità di segnale nelle sequenze a TR lungo e DWI. È importante sottolineare che l’alterazione della barriera emato-encefalica è preminente nelle regioni periventricolari nelle quali è particolarmente spiccato il metabolismo ossidativo e quindi la richiesta di tiamina. CONCLUSIONI L’encefalopatia di Wernicke deve essere sospettata in tutte le condizioni cliniche che comportano malassorbimento o malnutrizione L’unica metodica in grado di assicurare questo risultato è la RM, che mostra un’elevata sensibilità nella detezione delle lesioni (93% secondo Antunez), a fronte comunque di una specificità (53%) non sufficiente ad escludere la diagnosi, specie nei pazienti con sindrome clinica conclamata. L’esame standard in condizioni di base va integrato con studio DWI-ADC e, in caso di negatività nelle immagini dirette, va completato con sequenze ponderate in T1 acquisite dopo infusione e.v. di m.d.c. paramagnetico. Tuttavia va sottolineato che l’assenza di lesioni evidenziabili alla RM non consente di escludere con certezza la diagnosi.

We tested whether nonalcoholic fatty liver disease (NAFLD) and/or its histological severity are associated with vascular white matter lesions (WML) in patients with biopsy-proven NAFLD and in non-NAFLD controls. Data were recorded in 79 consecutive biopsy-proven NAFLD, and in 82 controls with normal ALT and no history of chronic liver diseases, without ultrasonographic evidence of steatosis and liver stiffness value 45 years (OR 3.09, 95% CI: 1.06–9.06, P = 0.03; and OR 11.1, 95% CI: 1.14–108.7, P = 0.03), and F2–F4 fibrosis (OR 3.36, 95% CI: 1.29–8.73, P = 0.01; and OR 5.34, 95% CI: 1.40–20.3, P = 0.01) were independently associated with WML (mostly of mild grade) by multivariate analysis. Among NAFLD, the prevalence of WML progressively increased from patients without (1/18; 5.5%), or with 1 (1/17, 5.8%), to those with 2 (9/30; 30%) and further to those with 3 (12/14; 85.7%) risk factors. The presence of WML is not associated with NAFLD, but with metabolic diseases in general, and fibrosis severity of NAFLD. Clinical implications of this issue need to be assessed by longitudinal studies.

High-resolution multidetector computed tomography with multiplanar reformations and 3-D postprocessing often provides the detail necessary for preoperative assessment of facial injuries. Maxillofacial fractures are classified in the following manner: upper face fractures, midface fractures (the most frequent), Le Fort fractures, and lower face or mandible fractures. The facial skeleton is a framework of vertical and horizontal buttresses that ensures a better resistance to trauma, but serves also as reference for maxillofacial surgery to restore facial size and shape. Radiologists should know how to diagnose and report the main types of facial fracture.

Purpose: To determine the utility of apparent diffusion coefficients (ADCs) for the characterisation of small solid renal lesions. Methods and Materials: 26 patients (GFR 30-60 mL/min) with 39 small (1-3 cm) solid renal masses [16 RCCs (10 clear cell types; 6 other types); 18 AMLs (10 fat-containing; 8 minimal-fat) and 5 oncocytomas] were examined on a 3 T system using DW-SS-EPI (b-values 0, 1000 s/mm2). The ADC of the lesions and the ADC of kidney were evaluated. Receiver operator characteristic analysis was performed to evaluate the diagnostic value of ADC for differentiating clear cell RCCs from other type RCCs, AMLs and oncocytomas. Results: The mean ADC of the lesions [1.22± 0.27 28 mm2 /sec (0.76-1.96)] was lower than that of kidney [1.85± 0.12 mm2 /sec (1.38-2.13)] (p< 0.005; Mann-Whitney test). The mean ADC was different between RCCs [1.23± 0.34 mm2 /sec (0.76-1.73)], AMLs [1.07 ± 0.1 mm2 /sec (0.85-1.28)] and oncocytomas [1.66± 0.28 mm2 /sec (1.1-1.96)] (p< 0.05, Kruskal-Wallis test). The mean ADC of clear cell RCCs was significantly higher than that of other RCCs [1.46± 0.34 mm2 /sec (1.04-1.73) vs 0.83 ± 0.34 (0.76-1.01)] (p< 0.005; Student t-test). There was no significant difference between mean ADC of fat-containing [1.06 ±0.48 mm2 /sec (0.86-1.28)] and minimal-fat AMLs [1.11 ±0.33 mm2 /sec (1.04-1.22)] (p=0.46; Student t-test). The best cut-off ADC value for differentiating clear cell RCCs from other RCCs, AMLs and oncocytomas were 1.5,1.12 and 1.73 mm2/sec, respectively. Conclusion: DWI is useful to differentiate benign from malignant small solid renal lesions.

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A key goal in designing an artificial intelligence capable of performing complex tasks is a mechanism that allows it to efficiently choose appropriate and relevant actions in a variety of situations and contexts. Nowhere is this more obvious than in the case of building a general intelligence, where the contextual choice and application of actions must be done in the presence of large numbers of alternatives, both subtly and obviously distinct from each other. We present a framework for action selection based on the concurrent activity of multiple forward and inverse models. A key characteristic of the proposed system is the use of simulation to choose an action: the system continuously simulates the external states of the world (proximal and distal) by internally emulating the activity of its sensors, adopting the same decision process as if it were actually operating in the world, and basing subsequent choice of action on the outcome of such simulations. The work is part of our larger effort to create new observation-based machine learning techniques. We describe our approach, an early implementation, and an evaluation in a classical AI problem-solving domain: the Sokoban puzzle.

Obiettivo. Scopo dello studio era valutare l’elasticità del tendine del sovraspinato nella spalla sintomatica di pazienti con sospetto clinico di rottura unilaterale della cuffia dei rotatori, e comparare i reperti riscontrati con quelli dell’ecografia convenzionale (ultrasound, US) e della risonanza magnetica (RM). Metodi. Nel periodo compreso tra gennaio e dicembre 2009 sono state esaminate da un radiologo entrambe le spalle di 58 pazienti (età media: 46 anni; range 32-58 anni) sia con modulo elastosonografico in real-time che in B-mode tramite uno stesso ecografo (EUB - Hitachi 7500), usando una sonda lineare a elevata frequenza (13 MHz). L’elasticità delle fibre tendinee del sovraspinato è stata valutata mediante uno score semiquantitativo di colori differenti rappresentanti tessuto rigido (blu) e tessuto via via più elastico (verde, giallo, rosso). I reperti riscontrati con elastosonografia ed ecografia convenzionale sono stati valutati separatamente da un secondo radiologo e quelli della spalla affetta comparati successivamente con quelli riscontrati a un esame RM eseguito in un arco temporale compreso tra 2 e 4 settimane dopo l’esame ecografico. L’esame RM è stato valutato da un terzo radiologo in cieco sul risultato dell’esame ecografico precedentemente eseguito. Risultati. Usando come gold-standard l’esame RM, l’elastosonografia ha correttamente diagnosticato in sette pazienti una lesione parziale rilevata come semplice tendinosi dall’esame B-mode verosimilmente a causa della presenza di tessuto di granulazione intralesionale ad ecostruttura simile a quella del tendine circostante. Inoltre, tre casi di lesione intratendinea riscontrati con l’US sono risultati essere, sia all’elastosonografia che alla RM, una lesione a tutto spessore. In tutti i casi (58/58) i reperti dell’esame RM hanno confermato quelli dell’elastosonografia, anche se in alcuni casi l’ampiezza della lesione appariva maggiore in RM, presumibilmente a causa dell’elevato segnale aggiuntivo dato dall’edema perilesionale. Conclusioni. L’esame elastosonografico è un metodo sensibile per la diagnosi di lesioni del tendine del sovraspinato, in particolare di quelle parziali e a tutto spessore su base degenerativa.

Aim of the present paper was to investigate the imaging and related clinical characteristics of sialolithiasis in Italian pediatric population trying to determine the difference between pediatric and adult. Twenty-nine pediatric patients (age range 1-17 years) with pain and postprandial swelling and/or purulent discharge in the salivary gland areas were referred to radiology department after pediatric ear, nose and throat (ENT) evaluation. They all were submitted to ultrasound examination of the main salivary glands. Multidetector computed tomography (MDCT) only was performed in 2/6 patients, in 2/6 patients both sialography and MDCT were performed due to inconclusive MDCT features, 2/6 only sialography was performed. Sialoliths were classified on their location and size. In 6 out of 29 patients (4 males, 2 females, age range 1-17 years) salivary stones were detected. Sialoliths were detected in 5/6 patients in the submandibular gland and 1/6 in the parotid gland. All sialoliths, excepted for a case of multiple sialoliths, were located in the distal part of the main salivary ducts. Imaging characteristics of sialolith in pediatric group are similar than in adult population in few aspects. In fact sialoliths are smaller in size and located more frequently in the distal part of the main salivary duct, than in adult, making sialography cannulation more complex and requiring short thickness in MDCT

We present an architectural approach to learning problem solving skills from demonstration, using internal models to represent problem-solving operational knowledge. Internal forward and inverse models are initially learned through active interaction with the environment, and then enhanced and finessed by observing expert teachers. While a single internal model is capable of solving a single goal-oriented task, it is their sequence that enables the system to hierarchically solve more complex task. Activation of models is goal-driven, and internal ”mental” simulations are used to predict and anticipate future rewards and perils and to make decisions accordingly. In this approach intelligent system behavior emerges as a coordinated activity of internal models over time governed by sound architectural principles. In this paper we report preliminary results using the game of Sokoban, where the aim is to learn goal-oriented patterns of model activations capable of solving the problem in various contexts.

Purpose Anterior cervical spinal surgery with fusion (ACSF) is the most widely used technique in the management of cervical spondylosis or disc herniation. A case of pharyngeal perforation after ACSF demonstrated by videofluorography and MDCT is described. Methods A 39-year-old man, recently undergone to ACSF for interbody C3-C5 fusion with anterior cervical plate and screws, was submitted to a pharingoesophageal videofluorography and 64 row-MDCT of the neck before and after oral administration of iodine contrast medium for persistent high dysphagia. Results In the plain radiograph a fractured screw was detected, anterolaterally displaced on the right to the cervical spine, outside the pharingeal lumen. After high-density (250% weight/volume) barium suspension administration the screw floated outside the pharingeal lumen at C4-C6 level, and an extraluminal leak of barium was observed. On CT MPR and 3D reformatted images confirmed the screw was fractured and displaced outside the plate in the retropharingeal space, anteriorly to C4, and also the hypothesis of posterior pharingeal wall damage, for the presence of gas bubbles in the retropharingeal space, thickening of prevertebral soft tissues, and contrast medium leak through a pharyngeal break in the retropharingeal space. Conclusions Imaging can play a role to correctly address the cause of disphagya after ACSF.

In the period between September 2008 and February 2009, we evaluated with knee radiography a group of 30 patients with known knee osteoarthritis (OA). For each patient, two weight-bearing views of the knee were acquired, the first with a standard antero-posterior (AP) technique, the latter with a posteroanterior (PA) technique with a 10° skull-caudal incidence. The radiographs obtained were evaluated blinded by two radiologist who assessed the medial femoro-tibial width (FTW). Statistical analysis of the results, carried out with the “t” Student test, showed a statistically significant difference about FTW values between the two radiographic views (t = 5.2331 for reader 1 and t=5.1970 for reader 2). In conclusion, we believe that the dedicated PA view of the knee is better than standard AP view for a correct assessment of medial FTW.

In this paper an automatic texture based volumetric region growing method for liver segmentation is proposed. 3D seeded region growing is based on texture features with the automatic selection of the seed voxel inside the liver organ and the automatic threshold value computation for the region growing stop condition. Co-occurrence 3D texture features are extracted from CT abdominal volumes and the seeded region growing algorithm is based on statistics in the features space. Each CT volume is composed by 230 slices, having 512 x 512 pixels as spatial resolution, and 12-bit gray level resolution. In this initial feasible study, 5 healthy volunteer acquisitions has been used. Tests have been performed on both basal phase and arterial phase images. Segmentation result shows the effectiveness of the proposed method: liver organ is correctly recognized and segmented, leaving out liver vessels form the segmented area and overcoming the “organ-splitting” problem. The goodness of the proposed method has been confirmed by manual liver segmentation results, having analogous and super-imposable behavior.

Purpose. This study assessed the usefulness of upright weight-bearing examination of the ankle/hind foot performed with a dedicated magnetic resonance (MR)imaging scanner in the evaluation of the plantar fascia in healthy volunteers and in patients with clinical evidence of plantar fasciitis. Materials and methods. Between January and March 2009, 20 patients with clinical evidence of plantar fasciitis (group A) and a similar number of healthy volunteers (group B) underwent MR imaging of the ankle/hind foot in the upright weight-bearing and conventional supine position. A 0.25-Tesla MR scanner (G-Scan, Esaote SpA, Genoa, Italy) was used with a dedicated receiving coil for the ankle/hind foot. Three radiologists, blinded to patients’ history and clinical findings, assessed in consensus morphological and dimensional changes and signal intensity alterations on images acquired in both positions, in different sequences and in different planes.Results. In group A, MR imaging confirmed the diagnosis in 15/20 cases; in 4/15 cases, a partial tear of the plantar fascia was identified in the upright weight-bearing position alone. In the remaining 5/20 cases in group A and in all cases in group B, the plantar fascia showed no abnormal signal intensity. Because of the increased stretching of the plantar fascia, in all cases in group A and B, thickness in the proximal third was significantly reduced (p