Semi-quantitative and qualitative evaluation of pial leptomeningeal collateral circulation in acute ischemic stroke of the anterior circulation: the Careggi Collateral Score

Introduction: The imaging of ischemic penumbra in acute stroke is a debated issue and establishing commonly accepted criteria is difficult. Computerized tomography-perfusion studies conducted in animals have showed that the modifications occurring in the brain parenchima are part of a dynamic and progressive process involving the microcirculation. The purpose of this paper is to propose a new angiographic classification of collateral circulation in patients with acute ischemic stroke, with a possible correlation with the clinical outcome. Materials and methods: The basal angiograms of 57 patients with acute ischemic stroke is the territory of anterior circulation secondary to a major occlusion, who underwent endovascular treatment, were retrospectively reviewed and collaterals were classified according to our novel Careggi Collateral Score in 6 grades (0-6). The clinical outcome after 3 months was evaluated with modified Rankin Scale. A ROC (receiver operating characteristic) curve analysis identified a cut-off value of 1. Results: Patients with favorable collateral circulation (grades 2-5) showed a significant correlation with good clinical outcome (modified Rankin Scale ≤2). Conclusions: The Careggi Collateral Score resulted a useful tool to evaluate the chance of obtaining a favorable result with endovascular treatment in patients with acute ischemic stroke in the anterior circulation secondary to the occlusion of a major artery

Non invasive diagnosis and anatomo-clinical correlations of macrocystic pancreatic neoplasia

Pancreatic cystic tumors represent an heterogeneous group of neoplasms with a various clinical outcome. The incidence of these neoplasia is growing if compared with the past and this is mainly due to the larger use of more and more performing imaging techniques. The role of MRI and in particular of Cholangio-Pancreato Magnetic Resonance (CPMR) seems to be fundamental in the characterization of these cystic lesions. Between May 2009 and May 2011 a hundred and seventy six (176) patients with a suspect cystic lesion of the pancreas were evaluated. All patients had already undergone ultrasound and/or CT scan. CPMR was realized in each patient. Among these patients we only considered 51 without neither solid lesions or pseudocysts nor clear signs of malignancy. We found 10 Serous Cystic Tumors (SCT), 7 Mucinous Cystic Tumors (MCT) and 34 Intraductal Papillary Mucinous Neoplasia (IPMN). Thirty two (32) out of 34 IPMN revealed at CPMR a communication with the main pancreatic duct. This sign is pathognomonic of these lesions. CPMR seems to be mandatory to discriminate IPMN among the other pancreatic cystic neoplasia. Its role is fundamental for an early diagnosis and to give the best chance of cure in these aggressive and insidious tumors

Congenital defects of pericardium: case reports and review of literature

Introduction: Pericardial defects are a rare condition, generally asymptomatic, due to failure in development of pericardial sac. They are difficult to detect, particularly the complete absence of the pericardium. At present magnetic resonance imaging (MRI) is considered the best performing exam and it could be the first choice in the diagnosis of agenesia of the pericardium. Materials and Methods: A comprehensive review of dedicated books and PubMed literature was performed and three clinical cases have been analyzed. Results: We report three cases , one with partial and two with total agenesia of the left pericardium, seen at our Institute and diagnosed at MRI as unexpected findings. Discussion: The diagnosis of a congenital defect of the pericardium is challenging, even for expert radiologists, because this kind of deformity does not provide specific clinical nor conventional radiology findings. Nowadays, the most effective instrument for a certain diagnosis is MRI, interlocked with electrocardiography

Multimodal imaging in the diagnosis and evaluation of intestinal malrotations in adults: a case report

Midgut malrotation is a congenital anomaly referring to either lack of or incomplete rotation of the fetal intestines around the axis of the superior mesenteric artery during fetal development. It is rare in adulthood and the true incidence is difficult to estimate because most patients are asymptomatic. The diagnosis is usually performed with several radiological and surgical methods. We report a case of a woman who presented with cramp-like abdominal pain localized to the right iliac fossa. The patient underwent abdominal ultrasound, radiological examination without and with contrast, and computed tomography with three-dimensional volume rendering reconstruction. Although small bowel follow-through is often enough to recognize the type of malrotation, using multimodal imaging may offer a better definition of this abnormality with a better definition of the kind of malrotation, by adding additional anatomical information. In our case, the imaging clearly showed malrotation of the small bowel with reverse rotation of the colon. Hence a multimodal imaging strategy proved useful for the diagnosis of intestinal malrotation in an adult afflicted by chronic cramp-like abdominal pain