Modic I changes size increase from supine to standing MRI correlates with increase in pain intensity in standing position: uncovering the "biomechanical stress" and "active discopathy" theories in low back pain

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Early re-emerging tremor after MRgFUS thalamotomy: case–control analysis of procedural and imaging features

PurposeThis study aimed to identify possible prognostic factors determining early tremor relapse after Magnetic Resonance guided Focused Ultrasound Surgery (MRgFUS) thalamotomy in patients with essential tremor (ET) and Parkinson’s disease (PD).MethodsNine patients (six ET and three PD) who underwent Vim MRgFUS thalamotomy in a single institution and developed early re-emergent tremor were analyzed. A control group of patients matched pairwise for sex, pathology, age, disease duration, and skull density ratio (SDR) was selected to compare the technical-procedural data and MR imaging evidence. MR imaging findings compared between groups included lesion shape and volume in multiparametric sequences, as well as Fractiona Anisotropy (FA) and Apparent Diffusion Coefficient (ADC) values derived from Diffusion Tensor Imaging Diffusion Weighted Imaging (DTI) and Diffusion Weighted Imaging (DWI) sequences.ResultsWe did not find statistically significant differences in gender and age between the two groups. Technical and procedural parameters were also similar in both treatment groups. In MRI analysis, we found lesions of similar size but with greater caudal extension in the control group with stable outcomes compared to patients with tremor relapse.ConclusionIn our analysis of early recurrences after thalamotomy with focused ultrasound, there were neither technical and procedural differences nor prognostic factors related to lesion size or ablation temperatures. Greater caudal extension of the lesion in patients without recurrence might suggest the importance of spatial consolidation during treatment

Radiological assessment of dementia: the Italian inter-society consensus for a practical and clinically oriented guide to image acquisition, evaluation, and reporting

Background: Radiological evaluation of dementia is expected to increase more and more in routine practice due to both the primary role of neuroimaging in the diagnostic pathway and the increasing incidence of the disease. Despite this, radiologists often do not follow a disease-oriented approach to image interpretation, for several reasons, leading to reports of limited value to clinicians. In our work, through an intersocietal consensus on the main mandatory knowledge about dementia, we proposed a disease-oriented protocol to optimize and standardize the acquisition/evaluation/interpretation and reporting of radiological images. Our main purpose is to provide a practical guideline for the radiologist to help increase the effectiveness of interdisciplinary dialogue and diagnostic accuracy in daily practice. Results: We defined key clinical and imaging features of the dementias (A), recommended MRI protocol (B), proposed a disease-oriented imaging evaluation and interpretation (C) and report (D) with a glimpse to future avenues (E). The proposed radiological practice is to systematically evaluate and score atrophy, white matter changes, microbleeds, small vessel disease, consider the use of quantitative measures using commercial software tools critically, and adopt a structured disease-oriented report. In the expanding field of cognitive disorders, the only effective assessment approach is the standardized disease-oriented one, which includes a multidisciplinary integration of the clinical picture, MRI, CSF and blood biomarkers and nuclear medicine

Eyes as Gateways for Environmental Light to the Substantia Nigra: Relevance in Parkinson’s Disease

Recent data indicates that prolonged bright light exposure of rats induces production of neuromelanin and reduction of tyrosine hydroxylase positive neurons in the substantia nigra. This effect was the result of direct light reaching the substantia nigra and not due to alteration of circadian rhythms. Here, we measured the spectrum of light reaching the substantia nigra in rats and analysed the pathway that light may take to reach this deep brain structure in humans. Wavelength range and light intensity, emitted from a fluorescent tube, were measured, using a stereotaxically implanted optical fibre in the rat mesencephalon. The hypothetical path of environmental light from the eye to the substantia nigra in humans was investigated by computed tomography and magnetic resonance imaging. Light with wavelengths greater than 600 nm reached the rat substantia nigra, with a peak at 709 nm. Eyes appear to be the gateway for light to the mesencephalon since covering the eyes with aluminum foil reduced light intensity by half. Using computed tomography and magnetic resonance imaging of a human head, we identified the eye and the superior orbital fissure as possible gateways for environmental light to reach the mesencephalon

Staged magnetic resonance-guided focused ultrasound thalamotomy for the treatment of bilateral essential tremor and Parkinson’s disease related tremor: a systematic review and critical appraisal of current knowledge

IntroductionEssential tremor (ET) and Parkinson’s Disease (PD) are debilitating neurodegenerative disorders characterized by tremor as a predominant symptom, significantly impacting patients’ quality of life. Magnetic Resonance-guided Focused Ultrasound (MRgFUS) Thalamotomy is an innovative therapeutic option for the treatment of unilateral medically refractory tremor with fewer adverse effects compared to traditional surgical interventions. A recent CE approval allows appropriate patients to have their second side treated.ObjectiveThe objective of this systematic review was to analyze available current knowledge about the use of MRgFUS for the treatment of bilateral ET and PD related tremor, to identify the effectiveness and the risks associated with bilateral treatment.MethodsEligible studies were identified by searching published studies in PubMed and Scopus databases from May 2014 to January 2024 and by identifying ongoing studies registered on the clinicaltrials.gov website. Data were summarized by considering the following information topics: the number of patients involved, the selected lesion target, the assessment tool used to evaluate clinical changes, the observed improvement, the reported side effects, and the time interval between the two treatments. The study was registered in PROSPERO (ID: CRD42024513178).ResultsNine studies were eligible for this review, 7 for ET and 2 for PD. The involved population included a variable number of patients, ranging from 1 to 11 subjects for ET and from 10 to 15 subjects for PD. The main lesional targets were the ventral intermediate nucleus of the thalamus, the pallidothalamic tract and the cerebellothalamic tract bilaterally. All studies investigated the tremor relief through the Clinical Rating Scale for Tremor (CRST) in patients with ET, and through the Unified Parkinson’s Disease Rating Scale (UPDRS) in patients with PD. A variable degree of improvement was observed, with all patients expressing overall satisfaction with the bilateral treatment. Adverse events were mild and transient, primarily involving gait disturbances, dysarthria, and ataxia. A standardized protocol for administering the two consecutive treatments was not identifiable; typically, the timing of the second treatment was delayed by at least 6 months.ConclusionAvailable evidence supports the effectiveness and safety of staged bilateral MRgFUS treatments for ET and PD-related tremor

Cognitive safety of focused ultrasound thalamotomy for tremor: 1-year follow-up results of the COGNIFUS part 2 study

IntroductionIn the COGNitive in Focused UltraSound (COGNIFUS) study, we examined the 6-month cognitive outcomes of patients undergoing MRgFUS thalamotomy. This study endorsed the safety profile of the procedure in terms of cognitive functions that cannot be evaluated in real-time during the procedure unlike other aspects. The aim of the COGNIFUS Part 2 study was to investigate the cognitive trajectory of MRgFUS patients over a 1-year period, in order to confirm long-term safety and satisfaction.MethodsWe prospectively evaluated the cognitive and neurobehavioral profile of patients with essential tremor (ET) or Parkinson’s Disease (PD) related tremor undergoing MRgFUS thalamotomy at 1 year-follow-up following the treatment.ResultsThe sample consists of 50 patients (male 76%; mean age ± SD 69.0 ± 8.56; mean disease duration ± SD 12.13 ± 12.59; ET 28, PD 22 patients). A significant improvement was detected at the 1 year-follow-up assessment in anxiety and mood feelings (Hamilton Anxiety rating scale 5.66 ± 5.02 vs. 2.69 ± 3.76, p ≤ <0.001; Beck depression Inventory II score 3.74 ± 3.80 vs. 1.80 ± 2.78, p = 0.001), memory domains (Rey Auditory Verbal Learning Test, immediate recall 31.76 ± 7.60 vs. 35.38 ± 7.72, p = 0.001 and delayed recall scores 5.57 ± 2 0.75 vs. 6.41 ± 2.48), frontal functions (Frontal Assessment Battery score 14.24 ± 3.04 vs. 15.16 ± 2.74) and in quality of life (Quality of life in Essential Tremor Questionnaire 35.00 ± 12.08 vs. 9.03 ± 10.64, p ≤ 0.001 and PD Questionnaire −8 7.86 ± 3.10 vs. 3.09 ± 2.29, p ≤ 0.001).ConclusionOur study supports the long-term efficacy and cognitive safety of MRgFUS treatment for ET and PD

Post-earthquake Distress and Development of Emotional Expertise in Young Adults

After a natural disaster like an earthquake about 15% of the population experience a post-traumatic stress disorder (PTSD). However, even those without a diagnosis of PTSD can suffer from disorders of the affective sphere, including anxiety, depression and alteration of emotion recognition. The objective of this study was to investigate the neuropsychological and emotional profile of students living in the earthquake-affected areas of L'Aquila, Italy. A group of students living in L'Aquila at the time of the 2009 earthquake was recruited, and compared to a control group of students not living in any earthquake-affected areas. Participants were assessed by means of the Beck Depression Inventory (BDI) scale, the State-Trait Anxiety Inventory (STAI), the Insomnia Severity Index (ISI), the Intolerance of Uncertainty Scale Short Form, the Uncertainty Response Scale (URS), the Anxiety Sensitivity Index 3 (ASI-3), and the Eysenck Personality Questionnaire-Revised Short Form (EPQ-RS). Participants also took part in two behavioral experiments aimed at evaluating their ability to recognize facial expressions (by means of the Ekman and Friesen Pictures of Facial Affect) and to evaluate emotionally evocative scenes (by means of the International Affective Picture System (IAPS)). Results showed that students living in the earthquake-affected areas had a general increase of anxiety and anticipation of threats. Moreover, students living in the earthquake-affected areas showed a significantly higher overall accuracy in recognizing facial expressions as compared to controls. No significant differences between the two groups were detected in the evaluation of emotionally evocative scenes. The novel result lies in the greater accuracy of earthquake victims in recognizing facial expressions, despite the lack of differences from controls in evaluating affective evocative scenes. The trauma exposure may have increased vigilance for threats in earthquake victims, leading them to systematically pay attention to potential signs of approaching threats, such as emotional facial expressions, thus progressively developing particular "emotional expertise.

CT and MR imaging of the thoracic aorta

At present time, both CT and MRI are valuable techniques in the study of the thoracic aorta. Nowadays, CT represents the most widely employed technique for the study of the thoracic aorta. The new generation CTs show sensitivities up to 100% and specificities of 98-99%. Sixteen and wider row detectors provide isotropic pixels, mandatory for the ineludible longitudinal reconstruction. The main limits are related to the X-ray dose expoure and the use of iodinated contrast media. MRI has great potential in the study of the thoracic aorta. Nevertheless, if compared to CT, acquisition times remain longer and movement artifact susceptibility higher. The main MRI disadvantages are claustrophobia, presence of ferromagnetic implants, pacemakers, longer acquisition times with respect to CT, inability to use contrast media in cases of renal insufficiency, lower spatial resolution and less availability than CT. CT is preferred in the acute aortic disease. Nevertheless, since it requires iodinated contrast media and X-ray exposure, it may be adequately replaced by MRI in the follow up of aortic diseases. The main limitation of MRI, however, is related to the scarce visibility of stents and calcifications