Unit of Neuroimaging and Neurointervention

Siena, Italy

Unit of Neuroimaging and Neurointervention

Siena, Italy
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Bertelli E.,University of Siena | Leonini S.,Unit of Neuroimaging and Neurointervention | Tinturini R.,University of Siena | Hadjistilianou T.,University of Siena | And 9 more authors.
American Journal of Neuroradiology | Year: 2016

BACKGROUND AND PURPOSE: Intra-arterial chemotherapy for retinoblastoma is not always a straightforward procedure, and it may require an adaptable approach. This study illustrates strategies used when the ophthalmic artery is difficult to catheterize or not visible, and it ascertains the effectiveness and safety of these strategies. MATERIALS AND METHODS: A retrospective study was performed on a series of 108 eyes affected by intraocular retinoblastoma and selected for intra-arterial chemotherapy (follow-up range, 6-82 months). We recognized 3 different patterns of drug delivery: a fixed pattern through the ophthalmic artery, a fixed pattern through branches of the external carotid artery, and a variable pattern through either the ophthalmic or the external carotid artery. RESULTS: We performed 448 sessions of intra-arterial chemotherapy, 83.70% of them through the ophthalmic artery and 16.29% via the external carotid artery. In 24.52% of eyes, the procedure was performed at least once through branches of the external carotid artery. In 73 eyes, the pattern of drug delivery was fixed through the ophthalmic artery; for 9 eyes, it was fixed through branches of the external carotid artery; and for 17 eyes, the pattern was variable. Statistical analysis did not show any significant difference in the clinical outcome of the eyes (remission versus enucleation) treated with different patterns of drug delivery. Adverse events could not be correlated with any particular pattern. CONCLUSIONS: Alternative routes of intra-arterial chemotherapy for intraocular retinoblastoma appear in the short term as effective and safe as the traditional drug infusion through the ophthalmic artery.

PubMed | Neuroradiology Unit, Nuovo Ospedale Civile S Agostino Estense, Karolinska University Hospital, University of Rome La Sapienza and 3 more.
Type: | Journal: Journal of neurointerventional surgery | Year: 2016

The purpose of this study was to evaluate the correlation between a novel angiographic score for collaterals and CT perfusion (CTP) parameters in patients undergoing endovascular treatment for acute ischemic stroke (AIS).103 patients (mean age 66.712.7; 48.5% men) with AIS in the anterior circulation territory, imaged with non-contrast CT, CT angiography, and CTP, admitted within 8h from symptom onset and treated with any endovascular approach, were retrospectively included in the study. Clinical, neuroradiological data, and all time intervals were collected. Careggi Collateral Score (CCS) was used for angiographic assessment of collaterals and the Alberta Stroke Program Early CT Score (ASPECTS) for semiquantitative analysis of CTP maps. Two centralized core laboratories separately reviewed angiographic data, whereas CT findings were evaluated by an expert neuroradiologist. Univariate and multivariate analysis were performed considering CCS both as an ordinal and a dichotomous variable.37/103 patients (35.9%) received intravenous tissue plasminogen activator. Median (IQR) ASPECTS was 9 (6-10) for admission CT, 9 (5-10) for cerebral blood volume (CBV) maps, 3 (2-3) for mean transit time maps, 3 (2-4), for cerebral blood flow maps, and 5 (3-7) for CTP mismatch. Univariate analysis showed a significant correlation between CCS and ASPECTS for all CTP parameters. Multivariate analysis confirmed an independent association only between CCS and CBV (p=0.020 when CCS was considered as a dichotomous variable, p=0.026 with ordinal CCS).A correlation between angiographic assessment of the collateral circulation and CTP seems to be present, suggesting that CCS may provide an indirect evaluation of the infarct core volume to consider for patient selection in AIS.

PubMed | General Hospital Of S Donato Darezzo, Unit of Neuroimaging and Neurointervention, Beth Israel Deaconess Medical Center, Santa Maria alle Scotte General Hospital and 2 more.
Type: Journal Article | Journal: PloS one | Year: 2015

Literature has suggested that changes in brain flow circulation occur in patients with multiple sclerosis. In this study, digital subtraction angiography (DSA) was used to measure the absolute CCT value in MS patients and to correlate its value to age at disease onset and duration, and to expand disability status scale (EDSS). DSA assessment was performed on eighty MS patients and on a control group of forty-four age-matched patients. CCT in MS and control groups was calculated by analyzing the angiographic images. Lesion and brain volumes were calculated in a representative group of MS patients. Statistical correlations among CCT and disease duration, age at disease onset, lesion load, brain volumes and EDSS were considered. A significant difference between CCT in MS patients (mean = 4.9s; sd = 1.27 s) and control group (mean = 2.8s; sd = 0.51 s) was demonstrated. No significant statistical correlation was found between CCT and the other parameters in all MS patients. Significantly increased CCT value in MS patients suggests the presence of microvascular dysfunctions, which do not depend on clinical and MRI findings. Hemodynamic changes may not be exclusively the result of a late chronic inflammatory process.

Monti L.,Unit of Neuroimaging and Neurointervention | Menci E.,Unit of Neuroimaging and Neurointervention | Piu P.,University of Siena | Leonini S.,Unit of Neuroimaging and Neurointervention | And 5 more authors.
American Journal of Neuroradiology | Year: 2014

BACKGROUND AND PURPOSE: The autonomic nervous system maintains constant cerebral venous blood outflow in changing positions. Alterations in cerebral autoregulation can be revealed by postural changes at quantitative color Doppler sonography. The aim of this study was to reach an optimal cutoff value of the difference between the cerebral venous blood outflow in the supine and seated positions that can discriminate healthy controls from patients with multiple sclerosis and those with other neurologic diseases and to evaluate its specificity, sensitivity, and diagnostic accuracy. MATERIALS AND METHODS: One hundred fifteen subjects (54 with MS, 31 healthy controls, 30 with other neurologic diseases) underwent a blinded quantitative color Doppler sonography evaluation of cerebral venous blood outflow in the supine and sitting positions. An optimal difference value between the supine and sitting positions of the cerebral venous blood outflow cutoff value was sought. RESULTS: The difference value between supine and sitting positions of the cerebral venous blood outflow was ≤ 503.24 in 38/54 (70.37%) patients with MS, 9/31 (29.03%) healthy controls, and 13/30 (43.33%) subjects with other neurological diseases. A difference value between supine and sitting positions of the cerebral venous blood outflow at a 503.24 cutoff reached a sensitivity at 70.37%, a 70.96% specificity, a 80.85% positive predictive value, and a 57.89% negative predictive value; the quantitative color Doppler sonography parameters yielded significant differences. The difference value between supine and sitting positions of cerebral venous blood outflow ≤ 503.24 assessed the significant difference between MS versus other neurological diseases. CONCLUSIONS: Alteration of cerebral venous blood outflow discriminated MS versus other neurologic diseases and MS versus healthy controls. The difference value between supine and sitting positions of cerebral venous blood outflow ≤ 503.24 was statistically associated with MS.

Cerase A.,Unit of Neuroimaging and Neurointervention | Grazzini I.,University of Siena
Journal of Stroke and Cerebrovascular Diseases | Year: 2015

Calcified cerebral emboli are rarely reported, but may be recurrent and devastating. Misdiagnosis at interpretation of initial brain computed tomography (CT) scan may occur in up to 27% of cases. The purpose of this case report was to describe clinical, CT, and CT angiography findings in a 79-year-old woman undergoing early recurrent stroke from calcified cerebral embolism. Neuroradiology should not overlook calcified cerebral embolism, and this confirms the role of CT in the assessment of stroke. © 2015 National Stroke Association.

Giannitti C.,University of Siena | Cerase A.,Unit of Neuroimaging and Neurointervention | Miracco C.,University of Siena | Fioravanti A.,University of Siena
Clinica Terapeutica | Year: 2011

Central nervous system involvement has been reported in up to 60% of patients with systemic lupus erythematosus (SLE). Cerebral vasculitis in SLE is rare and its incidence in post-mortem studies has been documented from 7% to 15% of cases. Cerebral haemorrhage is described in 0.4-7% of cases and it is usually due to inherent or iatrogenic factors (e.g., arterial hypertension, thrombocytopenia or anticoagulation). We report a case of cerebral haemorrhage in a patient with SLE and histologically proven cerebral vasculitis, leading to the death of the patient within 12 months. In the patient presented herein, the cerebral haemorrhage was not correlated to possible known causes of these events, apart from the long-term use of intravenous immunoglobulins. The authors discuss the possible role of intravenous immunoglobulin therapy as pathogenetic factor for cerebral vasculitis in this patient.

PubMed | Unit of Neuroimaging and Neurointervention
Type: Case Reports | Journal: Journal of neuro-ophthalmology : the official journal of the North American Neuro-Ophthalmology Society | Year: 2010

A 30-year-old woman developed acute visual loss and optic disc elevation in the left eye after breastfeeding her second son. The initial diagnosis was optic neuritis. However, MRI showed a lesion in left intraorbital and intracanalicular optic nerve and several cerebral lesions with imaging features of cerebral cavernous malformations (CCMs). Genetic testing was positive for abnormalities known to predispose to CCMs in the patient and her father, who also showed MRI evidence of CCMs. During a 44-month follow-up period in which no intervention took place, the patients vision in the affected eye fluctuated but eventually became extinguished. Serial MRIs did not always show lesion changes that explained the visual deterioration. In familial CCM, pregnancy might be a second hit to genetically predisposed tissue.

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