Supratentorial cerebral cavernous malformations: clinical, surgical, and genetic involvement

Object Although there is general agreement on the methods of treatment for symptomatic supratentorial cerebral cavernous malformations (CMs) located in noneloquent areas, some controversy exists regarding the management of cerebral CMs that are asymptomatic and/or located in eloquent or deep areas. Moreover, recent advances in genetic findings could influence both standard clinical management and the follow-up strategy in affected individuals. Thus, the objective of this study was to develop, based on the authors' experience and a literature review, a management algorithm to deal with supratentorial cerebral CMs. Methods The authors retrospectively reviewed the clinical data related to 118 patients who underwent surgery for symptomatic supratentorial cerebral CMs at their institution. Twenty-eight of 118 patients harbored multiple lesions, and nine of these 28 patients had a clinically positive familial history. Genetic investigations were performed in 89 patients (75%). Conclusions Surgery for supratentorial cerebral CMs in noneloquent locations is safe and curative. In cerebral CMs located in deep and eloquent areas and with symptoms including progressive neurological deficits, evidence of hemorrhage, and uncontrolled seizures, surgical treatment according to an integrated plan based on frameless stereotactic guidance and functional magnetic resonance imaging is recommended and results in acceptably low morbidity. The data support the need for long-term imaging follow up in all patients, careful preoperative vascular studies to detect associated venous anomalies, and the importance of genetic mutational analysis. The DNA screening protocol will change the care of family members of patients with familial forms of cerebral CMs, because affected asymptomatic family members may benefit by early detection of lesions. At the same time, the exclusion of family members who are not carriers of the mutation as members of the population at risk reduces the economic and psychological burden of clinical and instrumental monitoring

Proton MR spectroscopy of the brain at 3 T: An update

Proton magnetic resonance spectroscopy (1H-MRS) provides specific metabolic information not otherwise observable by any other imaging method. 1H-MRS of the brain at 3 T is a new tool in the modern neuroradiological armamentarium whose main advantages, with respect to the well-established and technologically advanced 1.5-T 1H-MRS, include a higher signal-to-noise ratio, with a consequent increase in spatial and temporal resolutions, and better spectral resolution. These advantages allow the acquisition of higher quality and more easily quantifiable spectra in smaller voxels and/or in shorter times, and increase the sensitivity in metabolite detection. However, these advantages may be hampered by intrinsic field-dependent technical issues, such as decreased T2 signal, chemical shift dispersion errors, J-modulation anomalies, increased magnetic susceptibility, eddy current artifacts, challenges in designing and obtaining appropriate radiofrequency coils, magnetic field instability and safety hazards. All these limitations have been tackled by manufacturers and researchers and have received one or more solutions. Furthermore, advanced 1H-MRS techniques, such as specific spectral editing, fast 1H-MRS imaging and diffusion tensor 1H-MRS imaging, have been successfully implemented at 3 T. However, easier and more robust implementations of these techniques are still needed before they can become more widely used and undertake most of the clinical and research 1H-MRS applications. © Springer-Verlag 2007

A rare case of isolated gallbladder rupture following blunt abdominal trauma

: Isolated gallbladder rupture are rare injuries. We present a case of gallbladder traumatic rupture in a 47-year-old patient involved in a motor vehicle collision, that presented abdominal pain with maximal intensity in the right upper quadrant.CT is the imaging technique of choice to diagnosis this entity, however the final diagnosis of gallbladder rupture is confirmed with laparoscopy. Cholecystectomy is the definitive treatment

www.elsevier.com/locate/ynimg Real-time independent component analysis of fMRI time-series

Real-time functional magnetic resonance imaging (fMRI) enables one to monitor a subject’s brain activity during an ongoing session. The availability of online information about brain activity is essential for developing and refining interactive fMRI paradigms in research and clinical trials and for neurofeedback applications. Data analysis for real-time fMRI has traditionally been based on hypothesis-driven processing methods. Off-line data analysis, conversely, may be usefully complemented by data-driven approaches, such as independent component analysis (ICA), which can identify brain activity without a priori temporal assumptions on brain activity. However, ICA is commonly considered a time-consuming procedure and thus unsuitable to process the high flux of fMRI data while they are acquired. Here, by specific choices regarding the implementation, we exported the ICA framework and implemented it into real-time fMRI data analysis. We show that, reducing the ICA input to a few points within a time-series in a sliding-window approach, computational times become compatible with real-time settings. Our technique produced accurate dynamic readouts of brain activity as well as a precise spatiotemporal history of quasistationary patterns in the form of cumulative activation maps and time courses. Results from real and simulated motor activation data show comparable performances for the proposed ICA implementation and standard linear regression analysis applied eithe

Prefrontal-Hippocampal Coupling During Memory Processing Is Modulated by COMT Val158Met Genotype

Background: Studies in humans and in animals have demonstrated that a network of brain regions is involved in performance of declarative and recognition memory tasks. This network includes the hippocampal formation (HF) as well as the ventrolateral prefrontal cortex (VLPFC). Studies in animals have suggested that the relationship between these brain regions is strongly modulated by dopamine. Methods: Using fMRI in healthy humans matched for a series of demographic and genetic variables, we studied the effect of the COMT val158met polymorphism on function of HF and VLPFC as well as on their functional coupling during recognition memory. Results: The COMT Val allele was associated with: relatively poorer performance at retrieval; reduced recruitment of neuronal resources in HF and increased recruitment in VLPFC during both encoding and retrieval; and unfavorable functional coupling between these two regions at retrieval. Moreover, functional coupling during retrieval was predictive of behavioral accuracy. Conclusions: These results shed new light on individual differences in responsivity and connectivity between HF and VLPFC related to genetic modulation of dopamine, a mechanism accounting at least in part for individual differences in recognition memory performanc

Cerebral neoplastic enhancing lesions: Multicenter, randomized, crossover intraindividual comparison between gadobutrol (1.0M) and gadoterate meglumine (0.5M) at 0.1mmolGd/kg body weight in a clinical setting

OBJECTIVE: Two macrocyclic extracellular contrast agents, one-molar neutral gadobutrol and ionic gadoterate meglumine, were compared to determine the overall preference for one or the other in a clinical setting. MATERIALS AND METHODS: Multicenter, randomized, single-blind, intra-individually controlled, comparison study with a corresponding blinded read. Efficacy analysis was based on 136 patients who underwent identical MRI examinations: group A first received 1.0M gadobutrol followed by 0.5M gadoterate meglumine 48 h to 7 days later; group B had a reversed administration order. Three independent blinded readers assessed off-site their overall diagnostic preference (primary efficacy parameter) based on a matched pairs approach. RESULTS: Superiority of gadobutrol over gadoterate meglumine was demonstrated for the qualitative assessment of overall preference across all readers by a statistically significant difference between both contrast agents for this primary endpoint. Preferences in lesion enhancement (secondary endpoint) were also found significantly in favor of gadobutrol. For preference in lesion delineation from surrounding tissue/edema and for internal structure only a trend towards a higher proportion for gadobutrol was found (except for internal structure reported by one reader, which showed a result of statistical significance). Lesion contrast and relative lesion enhancement (quantitative parameters) were statistically significantly higher for gadobutrol compared to gadoterate meglumine. CONCLUSION: Contrast-enhanced MRI of neoplastic brain lesions at a dose of 0.1 mmol Gd/kg body weight, assessed in a standardized off-site blinded reading, results in a significantly higher qualitative and quantitative preference for gadobutrol compared to gadoterate meglumine