Silvia Squarza

Malignant Incidental Extracardiac Findings on Cardiac CT: Systematic Review and Meta-Analysis

OBJECTIVE The objective of our study was to systematically review the evidence on incidental extracardiac findings on cardiac CT with a focus on previously unknown malignancies. MATERIALS AND METHODS A systematic search was performed (PubMed, EMBASE, Cochrane databases) for studies reporting incidental extracardiac findings on cardiac CT. Among 1099 articles initially found, 15 studies met the inclusion criteria. The references of those articles were hand-searched and 14 additional studies were identified. After review of the full text, 10 articles were excluded. Nineteen studies including 15,877 patients (64% male) were analyzed. A three-level analysis was performed to determine the prevalence of patients with incidental extracardiac findings, the prevalence of patients with major incidental extracardiac findings, and the prevalence of patients with a proven cancer. Heterogeneity was explored for multiple variables. Pooled prevalence and 95% CI were calculated. RESULTS The prevalence of both incidental extracardiac findings and major incidental extracardiac findings showed a high heterogeneity (I2>95%): The pooled prevalence was 44% (95% CI, 35-54%) and 16% (95% CI, 14-20%), respectively. No significant explanatory variables were found for using or not using contrast material, the size of the FOV, and study design (I2>85%). The pooled cancer prevalence for 10 studies including 5082 patients was 0.7% (95% CI, 0.5-1.0%), with an almost perfect homogeneity (I2<0.1%). Of 29 reported malignancies, 21 (72%) were lung cancers; three, thyroid cancers; two, breast cancers; two, liver cancers; and one, mediastinal lymphoma. CONCLUSION Although the prevalence of reported incidental extracardiac finding at cardiac CT was highly variable, a homogeneous prevalence of previously unknown malignancies was reported across the studies, for a pooled estimate of 0.7%; more than 70% of these previously unknown malignancies were lung cancers. Extracardiac findings on cardiac CT require careful evaluation and reporting.

Migraine with aura and white matter lesions: an MRI study

Several studies report the presence of white matter lesions on brain magnetic resonance imaging in patients with migraine. The aim of our study was to detect the entity of white matter T2-hyperintensities in 90 high selected patients affected by migraine with aura, compared to a group of 90 healthy controls. We found no significant difference of incidence of white matter alterations comparing these two groups.

Migraine with aura white matter lesions: preliminary data on clinical aspects

A few clinic-based magnetic resonance imaging studies report an increased risk of signal abnormalities in migraineurs brain’s white matter, especially in migraine with aura subjects. A vascular genesis has been hypnotized and migraine with aura was considered an independent risk factor for stroke. Available data of magnetic resonance imaging alterations are often nonspecific and sometimes controversial. The aim of our study is to investigate migraine with aura patients with standardized brain magnetic resonance imaging to detect and to quantify the presence of white matter lesions and to analyze their relation with clinical data. We report preliminary data about first 90 subjects. We did not recognize any clinical aspect in close relationship with these alterations. The only clinical feature that seems to play a role in the presence of alterations is the age, and only in migraineurs women.

Spontaneous Hematoma of the Rectus Sheath: Urgent Embolization with Squidperi Liquid Embolic Device

We treated a 78-year-old female affected by nontraumatic spontaneous rectus sheath hematoma. We decided to perform the embolization with the new liquid agent Squidperi. Complete exclusion of the bleeding vessel was obtained without complications. Its use should be considered for treatment of nontraumatic rectus sheath hematoma.

Headache in the emergency department: the role of imaging

Headache is a common problem in medical practice and can be the presenting feature of both benign and serious conditions. The International Classification of Headache Disorders divides all headache entities into primary and secondary. Primary headaches are those where there is no underlying cause identifiable and where the diagnosis is made through detailed history and pattern recognition. Secondary headaches are those where the headache is a symptom of an underlying cause that is identifiable on examination or investigation. Primary headaches are the most frequent type (approximately 90%), while secondary headaches account for 10% of all. By definition, primary headaches such as migraine, tension-type headache, or cluster headache have no underlying secondary cause [1]. Alarm signs and symptoms (red flags) that should be raise the suspicion of an underlying life-threatening condition are as follows:

Parry–Romberg syndrome: conventional and advanced MRI follow-up in a boy:

We studied a 9-year-old boy, affected with the Parry–Romberg syndrome, during a period of 32 months, by means of clinical evaluations and neuroradiological magnetic resonance imaging. Over this time we observed a clinical progression of the cutaneous disease without a simultaneous progression of the neurological alterations. Conventional and advanced magnetic resonance imaging techniques showed white matter alterations which proved to be stable during the follow-up.

Bronchial artery hypertrophy is correlated with coronary artery disease

Background Bronchial arteries support the systemic pulmonary vasculature and physiologically communicate with pulmonary arteries and coronary arteries. While there is evidence supporting the link between pulmonary diseases and bronchial artery hypertrophy (BAH), few data on the correlation between coronary artery disease (CAD) and BAH have been published. Purpose To evaluate a possible association between BAH and CAD in patients without known pulmonary diseases undergoing computed tomography coronary angiography (CTCA). Material and Methods This retrospective study was approved by the local ethics committee. One hundred patients with varying degrees of CAD underwent CTCA. Patients were stratified into four groups as follows: group I, 25 patients without CAD or with non-significant CAD; group II, 25 untreated patients with significant CAD; group III, 25 stented patients; group IV, 25 patients with coronary artery bypass grafts. The number and diameter of bronchial arteries were recorded. Correlation between age, CAD, and BAH was estimated. Results One hundred and ninety-nine bronchial arteries were detected. Approximately 51% were hypertrophic (diameter, >1.5 mm) with a mean diameter of 1.7 ± 0.5 mm. Seventy-six patients showed no pulmonary alterations; 24 were found to have previously undiagnosed pulmonary findings, six of which were severe. Presence and degree of CAD correlated with patients’ mean age (60 in group I, 68 in group II, 65 in group III, 69 in group IV; P = 0.023), and mean bronchial artery transverse diameter (1.6 mm, 1.7 mm, 1.8 mm, and 2.0 mm, respectively; P = 0.009). The bronchial artery diameter was not associated with pulmonary findings (P = 0.390). Conclusion There is an association between CAD and BAH. In patients with no pulmonary alterations, BAH could be caused by undiagnosed underlying CAD.

Magnetic resonance imaging in central nervous system vasculitis in a patient affected by crioglobulin-negative hepatitis C virus infection: A likely correlation

A 56-year-old man with behavioural disorders and facial-brachio-crural right hemiparesis presented with a brain lesion studied with computed tomography, magnetic resonance imaging and brain biopsy, leading to the diagnosis of cerebral vasculitis. Hepatitis C virus (HCV) infection in a phase of activity, without cryoglobulins, was also detected. Brain biopsy, laboratory analysis and response to a specific therapy supported the diagnosis of central nervous system vasculitis that was HCV related.

Percutaneous management of bone metastases: state of the art, interventional strategies and joint position statement of the Italian College of MSK Radiology (ICoMSKR) and the Italian College of Interventional Radiology (ICIR)

Interventional radiology provides local management of bone metastases (BM) with a palliative intent in most cases, or with a curative intent in selected patients. Its role has rapidly expanded in the last decade, offering new treatment solutions often in combination with surgery, radiation therapy and medical treatments. The aim of the present paper is to increase awareness, acceptance and adoption of interventional radiology procedures for the treatment of BM; and to present the joint position of the Italian College of Musculoskeletal Radiology and the Italian College of Interventional Radiology.

Brain MRI in patients affected by migraine with aura: is there any cortical lesion?

Migraine with typical aura (MWA), a common disorder affecting about 4–5% of the general population, consists of transient neurological dysfunction episodes usually followed by headache. Aura attacks clinically present initially as visual disturbances (90% of cases) that can be followed in a subgroup of patients, by somatosensory symptoms (about 10% of cases), reflecting a pathophysiological process that begins in the visual cortex and, in some patients, spreads from there to the parietal lobe and to the frontal lobe raising in this case speech alterations. It has been widely hypothesized that an underlying mechanism in migraine aura could be the cortical spreading depression (CSD), a slowly propagated (3 mm/min) wave of depolarization followed by suppression of brain activity. However, it is unknown why such cortical disturbances episodically occur in migraine patients. In addition, the longterm consequences of repeated migraine auras to the cerebral structure and function are still matter of study, although the condition is generally self-limiting and not associated with cognitive decline. MRI is a diagnostic tool often used in patients with MWA in order to exclude other underlying diseases. However, until today, no brain imaging abnormalities have been surely associated with migraine and no pathognomonic lesions have been recognized yet. The most common abnormalities described in literature are white matter T2 hyperintensities (WMH) [1, 2]. The relation between these white matter abnormalities and migraine is still not clear. Considering the physiopathology of MWA, attention should be focused on the cerebral cortex. Many studies support the relationship between CSD and aura phase inmigraine, while the relation between this phenomenon and migraine headache is still controversial. The latter being most probably due, according to some authors, to neuroplastic changes in cortical and subcortical structures of the trigeminal somatosensory system because of repetitive migraine attacks. A few studies in literature reported increased cortical thickness of visual and somatosensory areas in migraine patients compared to healthy controls. Other authors found out that cortical thickness and surface area were increased in regions involved in executive functions and visual motion processing, while were reduced in regions subserving pain processing, being all these abnormalities related to the presence of aura and WMHs. Moreover, in some studies, no differences in cortical thickness were found between migraine patients and healthy controls, nor any cortical abnormality. It is still not clear whether these changes, when present, indicate either an increased neuronal density that would render the tissue more susceptible to CSD or an altered structure, such as reactive gliosis, resulting frommultiple CSD episodes. Considering a possible role of cortical abnormalities in the physiopathologic process of migraine with aura, we decided to investigate if any cortical lesions such as reactive gliosis are detectable through MR imaging (without specific postprocessing software) in these patients. In a prospective longitudinal study made in our institution, 100 patients were recruited (from December 2015 to December 2017), all of them clinically diagnosed with * Carla Uggetti carla.uggetti@asst–santipaolocarlo.it