U. Salvolini

Multiparametric 3T MR approach to the assessment of cerebral gliomas: tumor extent and malignancy.

IntroductionContrast-enhanced MR imaging is the method of choice for routine assessment of brain tumors, but it has limited sensitivity and specificity. We verified if the addition of metabolic, diffusion and hemodynamic information improved the definition of glioma extent and grade.MethodsThirty-one patients with cerebral gliomas (21 high- and 10 low-grade) underwent conventional MR imaging, proton MR spectroscopic imaging (1H-MRSI), diffusion weighted imaging (DWI) and perfusion weighted imaging (PWI) at 3 Tesla, before undergoing surgery and histological confirmation. Normalized metabolite signals, including choline (Cho), N-acetylaspartate (NAA), creatine and lactate/lipids, were obtained by 1H-MRSI; apparent diffusion coefficient (ADC) by DWI; and relative cerebral blood volume (rCBV) by PWI.ResultsPerienhancing areas with abnormal MR signal showed 3 multiparametric patterns: “tumor”, with abnormal Cho/NAA ratio, lower ADC and higher rCBV; “edema”, with normal Cho/NAA ratio, higher ADC and lower rCBV; and “tumor/edema”, with abnormal Cho/NAA ratio and intermediate ADC and rCBV. Perienhancing areas with normal MR signal showed 2 multiparametric patterns: “infiltrated”, with high Cho and/or abnormal Cho/NAA ratio; and “normal”, with normal spectra. Stepwise discriminant analysis showed that the better classification accuracy of perienhancing areas was achieved when regarding all MR variables, while 1H-MRSI variables and rCBV better differentiated high- from low-grade gliomas.ConclusionMultiparametric MR assessment of gliomas, based on 1H-MRSI, PWI and DWI, discriminates infiltrating tumor from surrounding vasogenic edema or normal tissues, and high- from low-grade gliomas. This approach may provide useful information for guiding stereotactic biopsies, surgical resection and radiation treatment.

Posterior Corpus Callosum and Interhemispheric Transfer of Somatosensory Information: An fMRI and Neuropsychological Study of a Partially Callosotomized Patient

Interhemispheric somatosensory transfer was studied by functional magnetic resonance imaging (fMRI) and neuropsychological tests in a patient who underwent resection of the corpus callosum (CC) for drug-resistant epilepsy in two stages. The first resection involved the anterior half of the body of CC and the second, its posterior half and the splenium. For the fMRI study, the hand was stimulated with a rough sponge. The neuropsychological tests included: Tactile Naming Test (TNT), Same-Different Recognition Test (SDRT), and Tactile Finger Localization Test (intra- and intermanual tasks, TFLT). The patient was studied 1 week before and then 6 months and 1 year after the second surgery. Before this operation, unilateral tactile stimulation of either hand activated contralaterally the first (SI) and second (SII) somatosensory areas and the posterior parietal (PP) cortex, and SII and PP cortex ipsilaterally. All three tests were performed without errors. In both postoperative sessions, somatosensory activation was observed in contralateral SI, SII, and PP cortex, but not in ipsilateral SII and PP cortex. Performance was 100 correct in the TNT for the right hand, but below chance for the left; in the other tests, it was below chance except for TFLT in the intramanual task. This case provides the direct demonstration that activation of SII and PP cortex to stimulation of the ipsilateral hand and normal interhemispheric transfer of tactile information require the integrity of the posterior body of the CC.

Role of the corpus callosum in the somatosensory activation of the ipsilateral cerebral cortex: an fMRI study of callosotomized patients

To verify whether the activation of the posterior parietal and parietal opercular cortices to tactile stimulation of the ipsilateral hand is mediated by the corpus callosum, a functional magnetic resonance imaging (fMRI, 1.0 tesla) study was performed in 12 control and 12 callosotomized subjects (three with total and nine with partial resection). Eleven patients were also submitted to the tactile naming test. In all subjects, unilateral tactile stimulation provoked a signal increase temporally correlated with the stimulus in three cortical regions of the contralateral hemisphere. One corresponded to the first somatosensory area, the second was in the posterior parietal cortex, and the third in the parietal opercular cortex. In controls, activation was also observed in the ipsilateral posterior parietal and parietal opercular cortices, in regions anatomically corresponding to those activated contralaterally. In callosotomized subjects, activation in the ipsilateral hemisphere was observed only in two patients with splenium and posterior body intact. These two patients and another four with the entire splenium and variable portions of the posterior body unsectioned named objects explored with the right and left hand without errors. This ability was impaired in the other patients. The present physiological and anatomical data indicate that in humans activation of the posterior parietal and parietal opercular cortices in the hemisphere ipsilateral to the stimulated hand is mediated by the corpus callosum, and that the commissural fibres involved probably cross the midline in the posterior third of its body.

Proton MR spectroscopy of cerebral gliomas at 3 T: spatial heterogeneity, and tumour grade and extent

This study aimed to evaluate the usefulness of proton MR spectroscopic imaging (1H-MRSI) at 3 T in differentiating high- from low-grade gliomas, and tumour from necrosis, oedema or normal tissue. Forty-four patients with brain gliomas and four with meningiomas were retrospectively reviewed. The normalised metabolites choline (nCho), N-acetylaspartate (nNAA), creatine (nCr) and lactate/lipids (nLL), and the metabolite ratios Cho/NAA, NAA/Cr and Cho/Cr were calculated. Necrotic-appearing areas showed two spectroscopic patterns: “necrosis” with variable nCho and high nLL, and “cystic necrosis” with variable nLL or nonevident peaks. Peri-enhancing oedematous-appearing areas showed three spectroscopic patterns (“tumour” with abnormal Cho/NAA, “oedema” with normal Cho/NAA and “tumour/oedema” with normal nCho and abnormal Cho/NAA) in gliomas, and one (“oedema”) in meningiomas. Peri-enhancing or peri-tumour normal-appearing areas showed two patterns (“infiltrated” with abnormal nCho and/or Cho/NAA and “normal” with normal spectra) in gliomas and one (“normal”) in meningiomas. Discriminant analysis showed that classification accuracy between high- and low-grade glioma masses was better with normalised metabolites or all parameters together than metabolite ratios and that among peri-enhancing areas was much better with normalised metabolites. The analysis of spatial distribution of normalised metabolites by 3-T 1H-MRSI helps to discriminate among different tissues, offering information not available with conventional MRI.

Carotid stenosis : a comparison between MR and spiral CT angiography

Abstract We performed a preliminary study comparing three-dimensional time-of-flight (3 D TOF) magnetic resonance angiography (MRA) and spiral CT angiography (SCTA) in the detection and assessment of internal carotid artery stenosis. Digital subtraction angiography (DSA) was the reference examination. We examined 20 patients with signs of cerebrovascular insufficiency, who underwent MRA, SCTA and DSA within a 3 day period. Both internal carotid arteries were assessed by three blinded readers for degree of stenosis at two different levels (bulb and remaining section) giving a total of 80 assessments. Interobserver variability, sensitivity, specificity, diagnostic accuracy, concordance, overestimation and underestimation were assessed. Interobserver variability was not statistically significant. MRA showed higher sensitivity, specificity, diagnostic accuracy and concordance than SCTA (92.0 % vs 80.8 %, 98.2 % vs 96.4 %, 96.3 % vs 91.3 % and 96.0 % vs 88.0 %, respectively). MRA gave rise to a 5.0 % overestimation rate, whereas SCTA occasioned a 7.5 % underestimation rate. These differences are not statistically significant. These results suggest that MRA is a more useful, noninvasive modality for assessment of the internal carotid artery with a more than 70 % stenosis.

Topographical organization of human corpus callosum: An fMRI mapping study

The concept of a topographical map of the corpus callosum (CC) has emerged from human lesion studies and from anatomical tracing investigations in other mammals. Over the last few years, a rising number of researchers have been reporting functional magnetic resonance imaging (fMRI) activation in white matter, particularly the CC. In this study, the scope for describing CC topography with fMRI was explored by evoking activation through simple sensory stimulation and motor tasks. We reviewed our published and unpublished fMRI data on the cortical representation of tactile, gustatory, and visual sensitivity and of motor activation, obtained in 36 volunteers. Activation foci were consistently detected in discrete CC regions: anterior (taste stimuli), central (motor tasks), central and posterior (tactile stimuli), and splenium (visual stimuli). These findings demonstrate that the functional topography of the CC can be explored with fMRI.

Mucoceles in the paranasal sinuses involving the orbit: CT signs in 43 cases

SummaryThe diagnostic value of computed tomography was verified in the study of mucoceles in the paranasal sinuses involving the orbit. The CT data on 43 patients with clinical suspicion of mucocele highlight the characteristic signs; 26 were found to have a mucocele at operation.

Correlation between cerebral MRI abnormalities and mental retardation in patients with mucopolysaccharidoses.

Mucopolysaccharidoses (MPSs) are a group of inherited disorders due to lysosomal enzyme deficiencies which lead to multi‐organ accumulation of glycosaminoglycans. Some forms of MPS disorders are characterized by various degrees of mental retardation. Magnetic Resonance Imaging (MRI) is the primary imaging technique to detect CNS alterations. The aim of this study is to evaluate the correlation between white matter (WM) alterations and the presence of mental retardation. We analyzed 20 patients with different forms of MPSs, 11 with mental retardation and 9 with a normal cognitive function; all of them underwent brain MRI and received a score on the basis of the alterations (WM alterations; perivascular, subarachnoid, and ventricular space enlargement; abnormalities of the basal ganglia, of the corpus callosum and of the atlanto‐axial joint). All patients with mental retardation presented severe WM alterations, while only five out of the nine subjects without mental retardation showed certainly WM abnormalities. As far as the other cerebral abnormalities are concerned, no difference between the two groups has been found. These data seem to show that there is a significant correlation between the presence of WM alterations and mental retardation.

Traumatic injuries: imaging of facial injuries

Abstract. Facial injuries are common and require radiologic evaluation to plan treatment. The role of imaging is to detect fractures, describe their morphology and topography, and evaluate adjacent soft tissue damage. Computed tomography is the imaging method of choice for an accurate diagnosis and for depicting the complex anatomic structures of the maxillo-facial region. Magnetic resonance imaging plays a limited role, mainly in the assessment of lesions of orbital soft tissues. This paper reviews the most common traumatic injuries of facial bones, paranasal sinuses, orbits and mandible.

3.0-T functional brain imaging: a 5-year experience

The aim of this paper is to illustrate the technical, methodological and diagnostic features of functional imaging (comprising spectroscopy, diffusion, perfusion and cortical activation techniques) and its principal neuroradiological applications on the basis of the experience gained by the authors in the 5 years since the installation of a high-field magnetic resonance (MR) magnet. These MR techniques are particularly effective at 3.0 Tesla (T) owing to their high signal, resolution and sensitivity, reduced scanning times and overall improved diagnostic ability. In particular, the high-field strength enhances spectroscopic analysis due to a greater signal-to-noise ratio (SNR) and improved spectral, space and time resolution, resulting in the ability to obtain highresolution spectroscopic studies not only of the more common metabolites, but also – and especially – of those which, due to their smaller concentrations, are difficult to detect using 1.5-T systems. All of these advantages can be obtained with reduced acquisition times. In diffusion studies, the high-field strength results in greater SNR, because 3.0-T magnets enable increased spatial resolution, which enhances accuracy. They also allow exploration in greater detail of more complex phenomena (such as diffusion tensor and tractography), which are not clearly depicted on 1.5-T systems. The most common perfusion study (with intravenous injection of a contrast agent) benefits from the greater SNR and higher magnetic susceptibility by achieving dramatically improved signal changes, and thus greater reliability, using smaller doses of contrast agent. Functional MR imaging (fMRI) is without doubt the modality in which high-field strength has had the greatest impact. Images acquired with the blood-oxygen-level-dependent (BOLD) technique benefit from the greater SNR afforded by 3.0-T magnets and from their stronger magnetic susceptibility effects, providing higher signal and spatial resolution. This enhances reliability of the localisation of brain functions, making it possible to map additional areas, even in the millimetre and submillimetre scale. The data presented and results obtained to date show that 3.0-T morphofunctional imaging can become the standard for highresolution investigation of brain disease.