Intratumoral Haemorrhage Causing an Unusual Clinical Presentation of a Vestibular Schwannoma.

We present a case of an elderly woman with no history of audiological disease with sudden onset of visual and hearing deficits associated with systemic clinical signs. On examination she had impairment of right CNs from V to X. CT and MR imaging demonstrated a cystic vestibu- lar schwannoma with a rare intralesional fluid-fluid level correlated to a recent bleed. We include high quality MR images to show the acute impairment of the cranial nerves next to the tumour after acute bleeding. Our case report includes a voxel-based morphometry (VMB) analysis of the tumour that, as far as we know, has never been done before for such a tumour. VBM analysis was performed to calculate the hypothesized volume changes after the acute bleed which likely resulted in a sudden increase in the overall size of the tumour resulting in atypical clinical signs and symptoms due to the establishment of a mechanical conflict with the adjacent cranial nerves

Nasal anomalies review with CT or MRI: from congenital to malignant.

Learning Objectives. To describe imaging findings of a wide spectrum of uncommon nasal cavity masses evaluated at our institution by CT, CBCT and MR imaging, clinically and pathologically proven. Background. In this work we present a succinct review of disease illustrated by a retrospective case series of nasalcavity masses, evaluated at our institution. between 2010 and 2013. Patients have been studied with different imaging modalities including multiraw computed tomography (CT), cone beam computed tomography (CBCT) and magnetic resonance imaging (MR) to illustrate the findings and to summarize the main diagnostic keypoints for the differential diagnosis of nasal masses. Clinicopathological correlation is also reported and imaging findings we present have been isthopathologically proven. Images aid in recognition and characterization of the lesions. Many different types of lesions may involve the nasal cavities and imaging studies, CBCT, CT and MR, provide anatomical details and could be helpful first in differentiating benign to malignant lesions and secondary in characterization of the lesion. Referring to non neoplastic lesions, rinoliths, piogenic granuloma and septal mucocele are reported. Referring to benign and borderline tumors osteoma, hamartoma, hemangioma, hemangiopericytoma, cemento-ossifying fibroma, antrochoanal polip and inverted papilloma are reported. Referring to malignant neoplasms intestinal type adenocarcinoma, esthesioneuroblastoma and Non-Hodgkin lymphoma are reported. CONCLUSION. This review of uncommon nasal masses studied with different imaging modalities (CT, CBCT and MRI)should be useful in differential diagnosis of the wide spectrum of nasal tumors and non tumors masses

Presacral Myelolipoma

Many reports have described adrenal myelolipomas but there have been only a few reports of extra-adrenal myelolipomas. We describe a 74-year-old woman who came to our observa- tion for MRI of the lumbar spine for typical lumbar back pain. In addition to signs of mild scoliosis and spondylo disc arthrosis, MR imaging revealed a presacral mass showing a heterogeneously high signal in all pulse sequences and almost completely suppressed on inversion recovery sequences for fat tissue. CT imaging confirmed the fatty nature of the lesion and no signs of bone involvement. These findings were most consistent with a diagnosis of a rare presacral myelolipoma as confirmed at histopathologic analysis. This work reports a case of one of the rarest presacral masses, empha- sizing the role of imaging in the differential diagnosis of other presacral masses

Acceptance of non-invasive computed tomography coronary angiography: for a patient-friendly medicine

PURPOSE: This study was done to evaluate the psychological state and anxiety of patients undergoing computed tomography coronary angiography (CTCA), and assess their acceptance and satisfaction compared to invasive conventional coronary angiography (CCA). MATERIALS AND METHODS: A total of 442 consecutive patients (282 male; mean age 57.7 ± 9.5 years) who underwent CTCA for suspected or known coronary artery disease were evaluated with the Endler Multimodality Anxiety Scales (EMAS) before and after the scan, and a questionnaire administered after the scan. Among the 442 patients, 181 had a history of CCA. Two radiologists assessed the image quality of CTCA. RESULTS: Anxiety was more intense prior to the scan (EMAS score 51.7 vs. 46.7, p < 0.01) and in patients with a history of CCA (EMAS score 55.5 vs. 49.1, p < 0.01). Women presented more intense anxiety (EMAS score 59.5 vs. 47.3, p < 0.01), higher mean heart rate (63.5 ± 7.6 vs. 60.7 ± 7.3 beats per minute, p < 0.01) and a lower image quality than men (p < 0.0001). CTCA proved to be more acceptable than CCA because of accurate preparation, lower concern prior to the examination, negligible pain, higher comfort, and greater overall satisfaction (p < 0.0001). CONCLUSIONS: Computed tomography coronary angiography is a patient-friendly imaging method because of the minimal perceived discomfort. Anxiety may affect CTCA image quality in women

Plantar fascia evaluation with a dedicated magnetic resonance scanner in weight-bearing position: our experience in patients with plantar fasciitis and in healthy volunteers.

Purpose. This study assessed the usefulness of upright weight-bearing examination of the ankle/hind foot performed with a dedicated magnetic resonance (MR)imaging scanner in the evaluation of the plantar fascia in healthy volunteers and in patients with clinical evidence of plantar fasciitis. Materials and methods. Between January and March 2009, 20 patients with clinical evidence of plantar fasciitis (group A) and a similar number of healthy volunteers (group B) underwent MR imaging of the ankle/hind foot in the upright weight-bearing and conventional supine position. A 0.25-Tesla MR scanner (G-Scan, Esaote SpA, Genoa, Italy) was used with a dedicated receiving coil for the ankle/hind foot. Three radiologists, blinded to patients’ history and clinical findings, assessed in consensus morphological and dimensional changes and signal intensity alterations on images acquired in both positions, in different sequences and in different planes.Results. In group A, MR imaging confirmed the diagnosis in 15/20 cases; in 4/15 cases, a partial tear of the plantar fascia was identified in the upright weight-bearing position alone. In the remaining 5/20 cases in group A and in all cases in group B, the plantar fascia showed no abnormal signal intensity. Because of the increased stretching of the plantar fascia, in all cases in group A and B, thickness in the proximal third was significantly reduced (p<0.0001) under upright weight-bearing compared with the supine position Conclusions. Imaging the ankle/hind foot in the upright weight-bearing position with a dedicated MR scanner and a dedicated coil might enable the identification of partial tears of the plantar fascia, which could be overlooked in the supine position

ROLE OF IMAGING IN THE PREOPERATIVE ASSESSMENT OF PELVIC AND EXTRAPELVIC ENDOMETRIOSIS: A PICTORIAL ESSAY

-To create a MR radiological template for endometriosis -To review MR reports and images in patients with endometriosis to assess the accurancy of the reports

Microchimerism in multiple sclerosis: The association between sex of offspring and MRI features in women with multiple sclerosis

Aims: During pregnancy, fetal cells can migrate to the mother via blood circulation. A percentage of these cells survive in maternal tissues for decades generating a population of fetal microchimeric cells (fMCs), whose biological role is unclear. The aim of this study was to investigate the association between the sex of offspring, an indirect marker of fMCs, and magnetic resonance imaging (MRI) features in women with multiple sclerosis (MS). Methods: We recruited 26 nulliparous MS patients (NPp), 20 patients with at least one male son (XYp), and 8 patients with only daughters (XXp). Each patient underwent brain MR scan to acquire 3D-T2w FLAIR FatSat and 3D-T1w FSPGR/TFE. Lesion Segmentation Tool (LST) and FreeSurfer were used to obtain quantitative data from MRI. Additional data were collected using medical records. Multiple regression models were applied to evaluate the association between sex of offspring and MS data. Results: Comparing NPp and XXp, we found that NPp had larger 4th ventricle volume (2.02 ± 0.59 vs. 1.70 ± 0.41; p = 0.022), smaller left entorhinal volume (0.55 ± 0.17 vs. 0.68 ± 0.25; p = 0.028), and lower thickness in the following cortical areas: left paracentral (2.34 ± 0.16 vs. 2.39 ± 0.17; p = 0.043), left precuneus (2.27 ± 0.11 vs. 2.34 ± 0.16; p = 0.046), right lateral occipital (2.14 ± 0.11 vs. 2.25 ± 0.08; p = 0.006). NPp also had lower thickness in left paracentral cortex (2.34 ± 0.16 vs. 2.46 ± 0.17; p = 0.004), left precalcarine cortex (1.64 ± 0.14 vs. 1.72 ± 0.12; p = 0.041), and right paracentral cortex (2.34 ± 0.17 vs. 2.42 ± 0.14; p = 0.015) when compared to XYp. Comparing XYp and XXp, we found that XYp had higher thickness in left cuneus (1.80 ± 0.14 vs. 1.93 ± 0.10; p = 0.042) and left pericalcarine areas (1.59 ± 0.19 vs. 1.72 ± 0.12; p = 0.032) and lower thickness in right lateral occipital cortex (2.25 ± 0.08 vs. 2.18 ± 0.13; p = 0.027). Discussion: Our findings suggested an association between the sex of offspring and brain atrophy. Considering the sex of offspring as an indirect marker of fMCs, we speculated that fMCs could accumulate in different brain areas modulating MS neuropathological processes

SINCONAPP: A Computerized learning tool for CBCT normal anatomy and variants of the nose and paranasal sinuses

1. Purpose To supply an useful learning tool aimed to interactively display on mobile devices normal anatomy and variants of the nose and paranasal sinuses as seen on CBCT images. 2. Methods and Materials Images Images of the nose and paranasal sinuses were derived by a study series acquired by a CBCT device. CBCT studies of the paranasal sinuses were acquired in patients referred for nasal obstruction or sinusitis with the following parameters: 90 kVp, 12.5 mA, 20 s rotation time, FOV 13 x 14.5 cm, 0.25 x 0.25 x 0.25 mm voxel size. Software The application has been developed for iOS based mobile devices through the platform XCode provided by Apple®, and it is developed using the Objective-C programming language. The application has been configured as Master-Detail. This configuration splits the mobile device display in two panels. The left panel displays a list of the interesting items, while the right panel shows the relative details. Touching an item from the menu on the left panel, the textual description is shown on the same side, while the panel on the right will show the relative image. The application allows interactively navigation through normal anatomy and variants of the nose and paranasal sinuses, as represented on CBCT images in axial, sagittal and coronal planes. Cross-reference images to localize the same anatomic structures on different section planes are available. The navigation is intuitive, with multiple shortcuts. Different labels have been proposed in accordance with the specific anatomic lessic of the district and current literature references. High image quality with a zooming tool are available. 4. Conclusion An App for IOs devices was developed, that can represent an useful educational tool for medical students, residents and continuous medical education in radiology and other medical specialties dealing with nose and paranasal sinuses. This interactive atlas based on CBCT images could be also an useful option to be implemented on CBCT software

Relationship between anxiety level and radiological investigation. Comparison among different diagnostic imaging exams in a prospective single-center study

Objective: Every patient could feel anxious when he waits in a radiological department to undergo diagnostic exams. The aim of our study is to evaluate the impact of the radiological exams on patient anxiety. Materials and methods: We evaluated 343 patients (mean age 54.83 years) who underwent different types of diagnostic exams in the Department of Diagnostic Imaging at our Hospital from April 2013 to August 2014. We administered to patients the State and Trait Anxiety Inventory Test, which detected with high sensitivity both state anxiety and trait anxiety. A team of clinical psychologists and radiologists evaluated the scores obtained. Results: 83 out of 343 patients were excluded because refused to file the questionnaire. 31 % of the patients were submitted to MR, 18 % to breast imaging, 10 % to X-ray, 22 % Computer Tomography and 19 % to ultrasound, as previously described. 41 % of patients were submitted to the examination because of an oncologic disease, while 59 % because of non-oncological disease. Therefore, it was found that high levels of anxiety were present in most (about 91 %) of the patients and the scores varied according to the imaging examination and to the examination’s reason: anxiety level was higher in non-oncological patients (54 %) and in patients waiting to undergo to MRI exams (29 %). Conclusion: Our data suggest that the diagnostic exams are stressful events for the patient, also in non-oncological patients. So, it is important to adequate the radiological staff to receive the patient, to inform him and perform exams with emotive involvement with a targeted education. Also, further studies are needed to evaluate the anxiety level and the quality of the images, because the anxiety can result in a somatic disorder with hyperactivity of the autonomic nervous system which may affect the patient’s physical examination, causing problems in the evaluation of radiological images making to non-cooperative patient. MRI imaging is the examination that more of all led to an anxious state of patients but the main stressor is not related to the type of diagnostic examination, but to the uncertainty of the diagnosis, therapy and prognosis