Computed tomography angiography in the diagnosis of arteriovenous malformations

Introduction: The most common cause of intracranial bleeding in younger patients and children are vascular anomalies. Digital subtractions angiography presents a gold standard in diagnostics of aneurisms and vascular malformations. Our aim is to present our experience in using computed tomography angiography in diagnosing arteriovenous malformations. Methods: We included 150 patients with acute non-traumatic intracranial hemorrhage diagnosed by non-contrast CT examination, after which they were subjected to CT angiography of the cerebral vessels, and then underwent maximum intense projection and volume rendering reconstruction. Results:  Out of 150 patients with non-traumatic intracranial hemorrhage, in 121 (81%) a diagnosis of  aneurysm was rendered, while in 8 (5%) arteriovenous malformation was found. In 29 (14%) patients cause of bleeding was not identified. Patients with arteriovenous malformations, were age 17-77 years, with mean age 42.75 years. Five (62.5%) of them were female patients and three (37.5%) were male. Conclusion: Spontaneous non-traumatic intracranial hemorrhage is a significant cause of morbidity and mortality. Computed tomography angiography is sufficiently specific and sensitive in diagnosis of arteriovenous malformations in our experience

Early Introduction of cART Reverses Brain Aging Pattern in Well-Controlled HIV Infection: A Comparative MR Spectroscopy Study

Introduction: The aim of this study was to compare age-related changes in chronically infected, asymptomatic HIV-positive patients under combination antiretroviral therapy (cART), with age-, gender-, and educational-level-matched healthy subjects, using multi-voxel magnetic-resonance spectroscopy (MRS).Methods: There were 66 chronically infected HIV-positive subjects and 65 age-, gender-, and educational-level-matched control subjects, divided into four groups according to the age: group 1 (20–29 years old), group 2 (30–39), group 3 (40–49) and group 4 (50–59). MRS was performed and ratios of N-acetyl-aspartate (NAA)/creatine (Cr) were analyzed in ten locations of the supracallosal gray matter. For the comparison of NAA/Cr ratios in healthy and HIV-positive subjects, ANCOVA with age and education as covariates was performed. Correlations of NAA/Cr ratios with duration of cART were performed using Pearson’s correlation test. Statistical significance was set at p < 0.05.Results: The NAA/Cr ratios were decreased in the 20–29-year-old HIV-positive subjects in 8/10 locations (p < 0.005) compared to the healthy controls, while in the 50–59-year-old groups they were significiantly lower only in one location (p = 0.004). There were significant positive correlations of NAA/Cr levels with the duration of cART in the oldest group of HIV-positive subjects, while in the youngest group there were no significant correlations.Conclusion: The aging pattern in chronic HIV infection under cART is accentuated rather than accelerated. There is an initial HIV-related neuronal damage with a significant decline in NAA/Cr ratios; after the initiation of cART, however, NAA/Cr ratios increase continuously to become similar to healthy aging individuals, probably due to beneficial effect of long-standing cART.Summary: Brain aging in chronic HIV infection under cART is accentuated, with an initial HIV-related neuronal damage followed by a subtle NAA/Cr increase after the initiation of cART. Under cART, in advanced age, NAA/Cr ratios become similar to healthy aging individuals

2007 World Health Organization classification of tumours of the central nervous system

This article presents a brief review of the 2007 World Health Organization classification of tumours of the central nervous system

Neuroimaging in the Brain in HIV-1–Infected Patients

The brain may be affected by a variety of abnormalities in association with HIV infection. Knowledge of these abnormalities and their characteristic imaging features is important to neuroradiologists for the detection, diagnosis, and initiation of appropriate treatment. This review attempts to describe the imaging findings associated with brain disorders in HIV-seropositive patients and the rationales for integrating neuroradiologic techniques

Leptomeningeal Form of Immunoglobulin G4-Related Hypertrophic Meningitis with Perivascular Spread: A Case Report and Review of the Literature

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The Uses of Structural Neuroimaging in the Brain in HIV‐1‐Infected Patients

As the HIV/AIDS epidemic approaches the 20th anniversary of the first mysterious reports of people with the syndrome, researchers and clinicians continue to grapple with the complexities of the virus. HIV has been detected in the brain as early as 15 days after accidental intravenous inoculation. However, the mechanism of HIV‐related brain injury remains poorly understood. This review attempts to describe the imaging findings associated with brain disorders in HIV‐seropositive patients and the rationales for integrating neuroradiological techniques, including radionuclide techniques. HIV has nine genes and belongs to the lentivirus genus of retroviruses. HIV‐associated dementia (HAD) is now probably the most common cause of dementia worldwide among people aged 40 or less. The histopathological marker of the HIV‐infected brain is the presence of multinucleated giant cells (MGC). Several authors have claimed that neuroimaging studies are relatively insensitive in the detection of early changes in the brain due to HIV infection. Future diffusion tensor imaging (DTI) studies comparing diffusion changes with MRS and virological and immunological parameters will be helpful in further understanding the alterations in the HIV‐infected brain. Retinitis is one of the most common manifestations of cytomegalovirus (CMV) infection. In one study, MRS was used to distinguish HIV from CMV encephalitis. The findings suggest that a larger choline signal and a smaller N‐acetylaspartate (NAA) signal could be inferred within the white‐matter abnormalities due to HIV encephalitis/encephalopathy than in those due to CMV encephalitis

Susceptibility-weighted Imaging: Technical Essentials and Clinical Neurologic Applications

Susceptibility-weighted imaging (SWI) evolved from simple two-dimensional T2*-weighted sequences to three-dimensional sequences with improved spatial resolution and enhanced susceptibility contrast. SWI is an MRI sequence sensitive to compounds that distort the local magnetic field (eg, calcium and iron), in which the phase information can differentiate. But the term SWI is colloquially used to denote high-spatial-resolution susceptibility-enhanced sequences across different MRI vendors and sequences even when phase information is not used. The imaging appearance of SWI and related sequences strongly depends on the acquisition technique. Initially, SWI and related sequences were mostly used to improve the depiction of findings already known from standard two-dimensional T2*-weighted neuroimaging: more microbleeds in patients who are aging or with dementia or mild brain trauma; increased conspicuity of superficial siderosis in Alzheimer disease and amyloid angiopathy; and iron deposition in neurodegenerative diseases or abnormal vascular structures, such as capillary telangiectasia. But SWI also helps to identify findings not visible on standard T2*-weighted images: the nigrosome 1 in Parkinson disease and dementia with Lewy bodies, the central vein and peripheral rim signs in multiple sclerosis, the peripheral rim sign in abscesses, arterial signal loss related to thrombus, asymmetrically prominent cortical veins in stroke, and intratumoral susceptibility signals in brain neoplasms

Intradural spinal tumors: current classification and MRI features

The differential diagnosis of intradural spinal tumors is primarily based on location, but the clinical presentation, age, and gender of the patient are also important factors in determining the diagnosis. This comprehensive review focuses on the current classification, clinical symptoms, and MRI features of the more common intradural extramedullary and intramedullary neoplastic lesions. This review does not include extradural lesions