Publications by authors named "Giorgio Conte"

49 Publications

Impact of Cochlear Implant Array Placement on Speech Perception.

Clin Neuroradiol 2021 Jun 17. Epub 2021 Jun 17.

Audiology Unit, Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy.

Purpose: To assess the role of flat panel computed tomography (FPCT) in the evaluation of cochlear implant (CI) electrode position and its relation to speech perception.

Methods: From March 2015 to March 2019, we retrospectively enrolled deaf subjects ≥ 18 years who underwent unilateral CI by one surgeon, imaged with FPCT and assessed with disyllabic words score before CI and at 6 months of follow-up. We calculated the disyllabic score difference before CI and after CI (ΔSDS) and divided the subjects in favorable and unfavorable outcome groups using the median ΔSDS as a cutoff. We compared the demographic, clinical, electrode characteristics, and the CI positioning variables scalar position, surgical insertion depth (SID), linear insertion depth (LID), angular insertion depth (AID) and wrapping factor (WF).

Results: We studied 50 subjects (F/M = 27/23; median age = 60.5 years, IQR: 50-70 years). The median ΔSDS was 80% (interquartile range [IQR]: 60-100%) in quiet and 80% (IQR: 47.5-100%) in noise. Of the subjects 23 demonstrated a favorable outcome and had earlier age at CI (median 52 years; IQR 45-67 years versus median 62 years; IQR: 56-71 years p = 0.032) and a significantly higher SID (median: 4.02 mm IQR: 3.00-5.35 mm versus median: 2.94 mm IQR: 2.06-3.90 mm; p = 0.029). No difference was found for LID (p = 0.977), AID (p = 0.302), and WF (p = 0.224). A logistic regression model built with the age at CI, number of CI electrodes, and the SID was significant χ2 ((df = 3, N = 50) = 14.517, p = 0.002). The model explained 33.7% (Nagelkerke R2) of ΔSDS variance and correctly classified 76% of the cases.

Conclusion: The SID measured by FPCT predicts the ΔSDS at 6 months follow-up, alongside with age at implantation and number of CI electrodes.
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http://dx.doi.org/10.1007/s00062-021-01046-wDOI Listing
June 2021

Prognostic Value of Early Magnetic Resonance Imaging Patterns in Sudden Hearing Loss.

Audiol Neurootol 2021 Apr 23:1-11. Epub 2021 Apr 23.

Audiology Unit, Department of Specialistic Surgical Sciences, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.

Introduction: Sudden sensorineural hearing loss (SSHL) is a relatively frequent disease, but a sensitive marker or a reliable test to identify the underlying cause is still unavailable. Neuroradiology appears to offer the most promising tools, especially magnetic resonance imaging (MRI). In a recent study from our group, we explored the ability of MRI to detect subtle changes in the inner ear compartments by means of a 3D-fluid-attenuated inversion recovery sequence, aiming at identifying 3 distinct MRI patterns (haemorrhagic, inflammatory, brain-labyrinth barrier breakdown). In the present study, we contrasted the MRI patterns at onset with relevant prognostic factors, with the audiological features of each patient's SSHL and with treatment outcomes.

Methods: In this retrospective study, we enrolled 50 adult subjects (54.61 ± 18.26 years) with SSHL. They underwent an MRI within 72 h from admission, and 5 audiological evaluations: at admission, on the 5th day after the start of medical therapy, at the end of the first cycle of hyperbaric oxygen therapy, then 1 and 6 months later.

Results: Abnormalities of the MRI signal and/or post-contrast enhancement asymmetry of the cochlea ("pattern+ MRI") correlated with worse audiological outcomes at 1 month, but the different MRI patterns were not correlated with any specific prognostic model, despite rigid protocol settings. However, a significant difference was found for low-tone SSHL, which were always "pattern" negative at MRI (p = 0.01), and for profound SSHL which demonstrated a pattern+ MRI in 80% (p = 0.04). At the onset of SSHL, a pattern+ MRI was found in 29/50 cases (58.0%) and was related with lesser degree of recovery of pure-tone average at 1 month and lesser chance to retain the hearing threshold benefit in the long term. Given the limited numbers of patients enrolled so far, the relative impact of comorbidities on each MRI pattern remains uncertain. At 6 months, we observed a trend of greater and more stable recovery (p = 0.023) and less frequent recurrence of SSHL in patients with a normal MRI.

Conclusions: The 3 observed MRI patterns did not correlate consistently with specific audio-vestibular features or any peculiar aspect of the patient's clinical history. Larger series of patients with SSHL are needed, possibly from multicentric studies.
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http://dx.doi.org/10.1159/000515153DOI Listing
April 2021

Assessment of Frequency-Place Mismatch by Flat-Panel CT and Correlation With Cochlear Implant Performance.

Otol Neurotol 2021 01;42(1):165-173

Department of Neuroradiology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico.

Objective: To calculate the frequency allocation mismatch in a group of very selected cochlear implant (CI) recipients and to contrast it with the speech perception performances.

Study Design: Cross-sectional observational prospective study.

Settings: Tertiary Audiological Department, University hospital.

Patients: Fifteen adults receiving the same CI array by the same surgeon through a posterior tympanotomy, round window approach.

Main Outcome Measures: 1) High definition flat panel computed tomography (FPCT) control of the intracochlear position of each electrode contact, and computation of the relative frequency allocation mismatch; 2) analysis of speech perception outcomes in relation with the mismatch.

Results: Despite a consistent and reproducible surgical procedure with the same intracochlear array, significant deviations from the frequency allocation tables (FAT) assigned by default by the manufacturer were observed in this study.Their influences on speech perception performances were negligible in the simple tasks of words or sentences recognition in quiet (and, to a lesser extent also in noise). The greatest effect of a significant mismatch was observed for the vocal-consonant-vocal (VCV) sequences recognition under noise masking, the emotional and the linguistic prosody recognition, and the phonemes discrimination of the Auditory Speech Sound Evaluation (A§E) test.

Conclusions: The greatest frequency-to-place occurred at the high frequencies. The effect was rather irrelevant on simple words and sentences recognition, while it negatively impacted on the more complex perceptual tasks.
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http://dx.doi.org/10.1097/MAO.0000000000002967DOI Listing
January 2021

Corrigendum to 'Arterial Embolization and Second-Look in Spindle Cell Oncocytoma of the Pituitary Gland: Case Report and Review of Literature' [World Neurosurgery 142 (2020) 87-92].

World Neurosurg 2021 Apr 23;148:269. Epub 2021 Jan 23.

Unit of Neurosurgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy; "Aldo Ravelli" Research Center for Neurotechnology and Experimental Brain Therapeutics, University of Milan, Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.

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http://dx.doi.org/10.1016/j.wneu.2020.12.156DOI Listing
April 2021

Amyotrophic lateral sclerosis phenotypes significantly differ in terms of magnetic susceptibility properties of the precentral cortex.

Eur Radiol 2021 Jul 5;31(7):5272-5280. Epub 2021 Jan 5.

Department of Neurology-Stroke Unit and Laboratory of Neuroscience, Istituto Auxologico Italiano IRCCS, piazzale Brescia 20, Milan, Italy.

Objectives: The aim of our study was to investigate whether the magnetic susceptibility varies according to the amyotrophic lateral sclerosis (ALS) phenotypes based on the predominance of upper motor neuron (UMN)/lower motor neuron (LMN) impairment.

Methods: We retrospectively collected imaging and clinical data of 47 ALS patients (12 with UMN predominance (UMN-ALS), 16 with LMN predominance (LMN-ALS), and 19 with no clinically defined predominance (Np-ALS)). We further enrolled 23 healthy controls (HC) and 15 ALS mimics (ALS-Mim). These participants underwent brain 3-T magnetic resonance imaging (3-T MRI) with T1-weighted and gradient-echo multi-echo sequences. Automatic segmentation and quantitative susceptibility mapping (QSM) were performed. The skewness of the susceptibility values in the precentral cortex (SuscSKEW) was automatically computed, compared among the groups, and correlated to the clinical variables.

Results: The Kruskal-Wallis test showed significant differences in terms of SuscSKEW among groups (χ(3) = 24.2, p < 0.001), and pairwise tests showed that SuscSKEW was higher in UMN-ALS compared to those in LMN-ALS (p < 0.001), HC (p < 0.001), Np-ALS (p = 0.012), and ALS-Mim (p < 0.001). SuscSKEW was highly correlated with the Penn UMN score (Spearman's rho 0.612, p < 0.001).

Conclusion: This study demonstrates that the clinical ALS phenotypes based on UMN/LMN sign predominance significantly differ in terms of magnetic susceptibility properties of the precentral cortex. Combined MRI-histopathology investigations are strongly encouraged to confirm whether this evidence is due to iron overload in UMN-ALS, unlike in LMN-ALS.

Key Points: • Magnetic susceptibility in the precentral cortex reflects the prevalence of UMN/LMN impairment in the clinical ALS phenotypes. • The degree of UMN/LMN impairment might be well described by the automatically derived measure of SuscSKEW in the precentral cortex. • Increased SuscSKEW in the precentral cortex is more relevant in UMN-ALS patients compared to those in Np-ALS and LMN-ALS patients.
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http://dx.doi.org/10.1007/s00330-020-07547-5DOI Listing
July 2021

Multicentric Retrospective Evaluation of Five Classic Infantile Pompe Disease Subjects Under Enzyme Replacement Therapy With Early Infratentorial Involvement.

Front Neurol 2020 25;11:569153. Epub 2020 Nov 25.

Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca' Granda Ospedale Maggiore Policlinico, Neuroradiology Unit, Milan, Italy.

White matter (WM) abnormalities and ventricular enlargement in brain MRI are well-known features in infantile-onset Pompe disease (IOPD) in the era of enzyme replacement therapy (ERT). In this multicentric observational retrospective study, we report a small cohort of IOPD subjects under ERT treatment ( = 5, median age at MRI = 7.4 years, median period of treatment = 85 months) that showed the classic features of extensive supratentorial WM abnormalities but also unusual findings such as early infratentorial WM abnormalities and late supratentorial U-fiber involvement. Given the recent implementation of ERT and the rarity of the disease, a complete spectrum of presentation and understanding of progressive pathology in the brain of IOPD subjects in treatment remains underacknowledged. The availability of long-term follow-up of IOPD subjects under ERT treatment allows a better insight into the evolution of brain abnormalities in such disease.
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http://dx.doi.org/10.3389/fneur.2020.569153DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7732650PMC
November 2020

Glue embolization of a pial arteriovenous fistula of the spinal artery.

Acta Biomed 2020 09 23;91(10-S):e2020004. Epub 2020 Sep 23.

Operative Unit of Neuoradiology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy. Via Francesco Sforza 35, 20122, Milano, Italy.

There are no clear guidelines about the treatment Pial Arteriovenous Fistulae (PAVF). For high-risk and severally symptomatic fistulae surgery is the first choice of treatment, including feeding artery ligation, surgical resection, radiosurgery and endovascular embolization techniques. We described a case of a patient with a symptomatic PAVF at the craniocervical junction fed by the anterior spinal artery, successfully treated with endovascular approach consisting of glue embolization of the feeding vessel.
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http://dx.doi.org/10.23750/abm.v91i10-S.10282DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8023074PMC
September 2020

Branch vessel occlusion in aneurysm treatment with flow diverter stent.

Acta Biomed 2020 09 23;91(10-S):e2020003. Epub 2020 Sep 23.

Operative Unit of Neuoradiology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy. Via Francesco Sforza 35, 20122, Milano, Italy.

Flow diverter placement for treatment of intracranial aneurysms gained growing consensus in the past years. A major concern among professionals is the side branch coverage which leads in some cases to vessel occlusion. However, the lost vessel patency only infrequently is accompanied by a new onset of neurological deficits secondary to ischaemic lesions. A retrospective analysis of all patients treated with flow diversion at our hospital was aimed to better understand this phenomenon in order to formulate a hypothesis about the causes. We concluded that vessel occlusion occurs due to a reduced blood pressure gradient in those vessels with a strong collateral or anastomotic vascularization that refurnishes the same distal vascular territories. Indeed, we detected no new brain infarction since blood flow was always guaranteed.
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http://dx.doi.org/10.23750/abm.v91i10-S.10283DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8023076PMC
September 2020

Iron deposition in Parkinsonisms: A Quantitative Susceptibility Mapping study in the deep grey matter.

Eur J Radiol 2020 Dec 2;133:109394. Epub 2020 Nov 2.

Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Neuroradiology Unit, Milan, Italy.

Purpose: The aim of the study is to quantify the susceptibility in deep grey nuclei that are affected by pathological processes related to iron accumulation in patients with Parkinson's disease and primary atypical parkinsonisms such as Progressive Supranuclear Palsy, Multiple System Atrophy and Cortico-Basal Degeneration, in order to assist the differential diagnosis among parkinsonian syndromes.

Methods: We enrolled 49 patients with Parkinson's disease and 26 patients with primary atypical parkinsonisms. Automatic segmentation of putamen, globus pallidus, caudate nucleus and thalamus and manual segmentation of red nuclei and substantia nigra were performed, and region of interest-based Quantitative Susceptibility Mapping analysis were performed. Statistical comparisons of the mean susceptibility values in the segmented brain regions were performed among primary atypical parkinsonisms and Parkinson's disease.

Results: Susceptibility values in red nuclei were increased in Progressive Supranuclear Palsy patients compared to parkinsonian phenotype Multiple System Atrophy (p = 0.004), and Parkinson's disease patients (p = 0.006). Susceptibility in thalamus was decreased in Cortico-Basal Degeneration patients compared to Parkinson's disease (p = 0.006), Multiple System Atrophy with cerebellar phenotype (p = 0.031) and parkinsonian phenotype (p = 0.001) patients, and in Progressive Supranuclear Palsy patients compared to Multiple System Atrophy with parkinsonian phenotype patients (p = 0.012).

Conclusions: Quantitative Susceptibility Mapping allows the depiction and quantification of different patterns of iron deposition in the deep gray nuclei occurring in primary atypical parkinsonisms and Parkinson's disease and it may help as a non-invasive tool in the differential diagnosis between parkinsonian syndromes.
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http://dx.doi.org/10.1016/j.ejrad.2020.109394DOI Listing
December 2020

Parieto-occipital sulcus widening differentiates posterior cortical atrophy from typical Alzheimer disease.

Neuroimage Clin 2020 28;28:102453. Epub 2020 Sep 28.

Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, via F. Sforza, 35, 20122 Milan, Italy; Department of Biomedical, Surgical and Dental Sciences, Dino Ferrari Center, CRC Molecular Basis of Neuro-Psycho-Geriatrics Diseases, University of Milan, Milan, Italy.

Objectives: Posterior Cortical Atrophy (PCA) is an atypical presentation of Alzheimer disease (AD) characterized by atrophy of posterior brain regions. This pattern of atrophy is usually evaluated with Koedam visual rating scale, a score developed to enable visual assessment of parietal atrophy on magnetic resonance imaging (MRI). However, Koedam scale is complex to assess and its utility in the differential diagnosis between PCA and typical AD has not been demonstrated yet. The aim of this study is therefore to spot a simple and reliable MRI element able to differentiate between PCA and typical AD using visual rating scales.

Methods: 15 patients who presented with progressive complex visual disorders and predominant occipitoparietal hypometabolism on PET-FDG were selected from our centre and compared with 30 typical AD patients and 15 healthy subjects. We used previously validated visual rating scales including Koedam scale, which we divided into three major components: posterior cingulate, precuneus and parieto-occipital. Subsequently we validated the results using the automated software Brainvisa Morphologist and Voxel Based Morphometry (VBM).

Results: Patients with PCA, compared to typical AD, showed higher widening of the parieto-occipital sulcus, assessed both with visual rating scales and Brainvisa. In the corresponding areas, the VBM analysis showed an inverse correlation between the results obtained from the visual evaluation scales with the volume of the grey matter and a direct correlation between the same results with the cerebrospinal fluid volume.

Conclusions: A visually based rating scale for parieto-occipital sulcus can distinguish Posterior Cortical Atrophy from typical Alzheimer disease.
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http://dx.doi.org/10.1016/j.nicl.2020.102453DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7559336PMC
June 2021

A susceptibility-weighted imaging qualitative score of the motor cortex may be a useful tool for distinguishing clinical phenotypes in amyotrophic lateral sclerosis.

Eur Radiol 2021 Mar 4;31(3):1281-1289. Epub 2020 Sep 4.

Department of Neurology-Stroke Unit and Laboratory of Neuroscience, Istituto Auxologico Italiano IRCCS, piazzale Brescia 20, Milan, Italy.

Objectives: To distinguish amyotrophic lateral sclerosis (ALS) and its subtypes from ALS mimics and healthy controls based on the assessment of iron-related hypointensity of the primary motor cortex in susceptibility-weighted imaging (SWI).

Methods: We enrolled 64 patients who had undergone magnetic resonance imaging studies with clinical suspicions of ALS. The ALS group included 48 patients; the ALS-mimicking disorder group had 16 patients. The ALS group was divided into three subgroups according to the prevalence of upper motor neuron (UMN) or lower motor neuron (LMN) impairment, with 12 subjects in the UMN-predominant ALS group (UMN-ALS), 16 in the LMN-predominant ALS group (LMN-ALS), and 20 with no prevalent impairment (C-ALS). The Motor Cortex Susceptibility (MCS) score was defined according to the hypointensity of the primary motor cortex in the SWI sequence. Its diagnostic accuracy in differentiating groups was evaluated.

Results: The MCS was higher in the ALS group than in the healthy control and ALS-mimicking disorder groups (p < 0.001). Among ALS subgroups, the MCS was significantly higher in the UMN-ALS group than in the healthy control (p < 0.001), ALS-mimicking disorder (p = 0.002), and LMN-ALS groups (p = 0.002) and higher in the C-ALS group than in the healthy control group (p = 0.019). An MCS value ≥ 2 showed specificity and a positive predictive value of 100% in the detection of both UMN-ALS and C-ALS patients.

Conclusions: The assessment of MCS in the SWI sequence could be a useful tool in supporting diagnosis in patients suspicious for ALS with prevalent signs of UMN impairment or with no prevalence signs of UMN or LMN impairment.

Key Points: • The hypointensity of the primary motor cortex in susceptibility-weighted imaging could support the diagnosis of ALS. • Our new qualitative score called MCS shows high specificity and positive predictive value in differentiating ALS patients with upper motor neuron impairment from patients with ALS-mimicking disorders and healthy controls.
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http://dx.doi.org/10.1007/s00330-020-07239-0DOI Listing
March 2021

Changes in appearance of cortical formation abnormalities in the foetus detected on sequential in utero MR imaging.

Eur Radiol 2021 Mar 4;31(3):1367-1377. Epub 2020 Sep 4.

Pediatric Radiology and Neuroradiology Department, Children's Hospital V. Buzzi, Milan, Italy.

Objectives: We describe 64 foetuses with cortical formation abnormalities (CFA) who had two in utero magnetic resonance (iuMR) exams, paying particular detail to those in which the original classification of CFA category changed between the two studies. The goal was to attempt to quantify the value of third-trimester follow-up studies in CFA foetuses on second-trimester iuMR imaging.

Methods: The 64 foetuses reviewed came from a CFA cohort of 374 foetuses reported in an earlier publication, which detailed a classification for foetal CFA. A consensus panel of senior paediatric neuroradiologists reviewed both studies, described any change in the category of CFA between them, and attempted to predict the possible clinical significance of any differences based on the combined clinical experience of the panel.

Results: In 40/64 (62%) foetuses, the CFA description was the same on both studies. In 24/64 (38%) cases, there was a category change which included three foetuses without CFA on first examination, six foetuses where the difference involved change in laterality/symmetry, and in 15 cases the re-classification involved categorical change within the same group. Brain abnormalities other than CFA were present in 30/64 (47%) foetuses on the first study and in 33/64 (52%) on the second. We predicted that prognosis would have changed on the basis of the second study in 8% of cases, all indicating worse prognosis.

Conclusions: We have shown that the extra diagnostic and predicted prognostic yield justifies follow-up studies in the third trimester if a CFA is shown on the second-trimester iuMR imaging.

Key Points: • Sixty-four foetuses with cortical formation abnormalities had two iuMR studies, for the vast majority the baseline in the second trimester and the sequential in the third. • In three foetuses, the cortical formation abnormality (CFA) was not visible on the first study. In a further 21 foetuses, the categorical description of the CFA changed between the two studies. Prognosis changed in 8% of the cases following the second iuMR study, and in all cases, the prognosis was worse. • Multiple iuMR studies provide information about the natural history of CFA; the extra diagnostic and predicted prognostic yield justifies follow-up studies.
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http://dx.doi.org/10.1007/s00330-020-07125-9DOI Listing
March 2021

Pediatric otogenic cerebral venous sinus thrombosis: a case report and a literature review.

Ital J Pediatr 2020 Sep 3;46(1):122. Epub 2020 Sep 3.

Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Paediatric Highly Intensive Care Unit, Milan, Italy.

Background: Cerebral venous sinus thrombosis in children is a rare but potentially fatal complication of acute mastoiditis, one of the most common pediatric infectious diseases. Due to its subtle clinical presentation, suspicion is essential for a prompt diagnosis and appropriate management. Unfortunately, no standard treatment options are available. To discuss the possible clinical presentation, microbiology, and management, we here report the case of a child with otogenic cerebral venous sinus thrombosis and perform a literature review starting from 2011.

Case Presentation: The child, a 10-months-old male, presented clinical signs of right acute otitis media and mastoiditis. Brain computed tomography scan detected right sigmoid and transverse sinus thrombosis, as well as a subperiosteal abscess. Fusobacterium necrophorum and Haemophilus Influentiae were detected on cultural sampling. A multidisciplinary approach along with a combination of medical and surgical therapy allowed the patient's full recovery.

Conclusion: Cerebral venous sinus thrombosis is a rare but severe complication of acute otitis media and mastoiditis. The management of this pathological condition is always challenging and an interdisciplinary approach is frequently required. Current therapeutic options include a combination of medical and surgical therapy. A patient-centered approach should guide timing and treatment management.
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http://dx.doi.org/10.1186/s13052-020-00882-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7470606PMC
September 2020

MYH2 myopathy, a new case expands the clinical and pathological spectrum of the recessive form.

Mol Genet Genomic Med 2020 09 24;8(9):e1320. Epub 2020 Jun 24.

Neuromuscular and Rare diseases Unit, Department of Neuroscience, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.

Background: Hereditary myosin myopathies are a group of rare muscle disorders, caused by mutations in genes encoding for skeletal myosin heavy chains (MyHCs). MyHCIIa is encoded by MYH2 and is expressed in fast type 2A and 2B muscle fibers. MYH2 mutations are responsible for an autosomal dominant (AD) progressive myopathy, characterized by the presence of rimmed vacuoles and by a reduction in the number and size of type 2A fibers, and a recessive early onset myopathy characterized by complete loss of type 2A fibers. Recently, a patient with a homozygous mutation but presenting a dominant phenotype has been reported.

Methods: The patient was examined thoroughly and two muscle biopsies were performed through the years. NGS followed by confirmation in Sanger sequencing was used to identify the genetic cause.

Results: We describe the second case presenting with late-onset ophthalmoparesis, ptosis, diffuse muscle weakness, and histopathological features typical for AD forms but with a recessive MYH2 genotype.

Conclusion: This report contributes to expand the clinical and genetic spectrum of MYH2 myopathies and to increase the awareness of these very rare diseases.
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http://dx.doi.org/10.1002/mgg3.1320DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7507101PMC
September 2020

Arterial Embolization and Second-Look in Spindle Cell Oncocytoma of the Pituitary Gland: Case Report and Review of Literature.

World Neurosurg 2020 10 7;142:87-92. Epub 2020 Jun 7.

Unit of Neurosurgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy; ‟Aldo Ravelli" Research Center for Neurotechnology and Experimental Brain Therapeutics, University of Milan, Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.

Background: Spindle cell oncocytomas are extremely rare neoplasms of the sellar, parasellar, and suprasellar regions that can frequently mimic pituitary adenomas. Fewer than 50 cases have been ever reported in the literature, and there is no consensus on best treatments to be provided.

Case Description: We hereby present a challenging case of sellar and suprasellar spindle cell oncocytoma in a patient of 64 years. The patient, who presented with hydrocephalus, hypopituitarism, and visual deficit, underwent urgent transsphenoidal (TNS) resection of the mass, which was aborted for massive life-threatening bleeding. The patient received ventriculoperitoneal shunt with relief of symptoms. An endovascular embolization of tumor feeders from the distal portion of the right internal maxillary artery, in particular the sphenopalatine artery, was then performed and a second-look TNS surgery was feasible. The patient was discharged in optimal clinical condition, recovered both endocrinologic and visual deficits, and is now in follow-up.

Conclusions: We found that the oncocytoma was radiologically and clinically comparable with a pituitary adenoma, except for higher representation of vasculature. According to our recent experience and review of the literature, we believe that surgery (transsphenoidal or transcranial approach) is the recommended treatment in those who are symptomatic and preoperative embolization might be a suitable option to reduce intraoperative bleeding and increase radicality.
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http://dx.doi.org/10.1016/j.wneu.2020.05.255DOI Listing
October 2020

Cortical formation abnormalities on foetal MR imaging: a proposed classification system trialled on 356 cases from Italian and UK centres.

Eur Radiol 2020 Oct 13;30(10):5250-5260. Epub 2020 May 13.

Academic Unit of Radiology, University of Sheffield, Sheffield, UK.

Objective: To formulate a classification system for foetal cortical formation abnormalities (CFAs) based on in utero magnetic resonance (iuMR) appearances and trial it in 356 cases.

Methods: This retrospective study included all cases of foetal CFA diagnosed between 2000 and 2017 from seven centres in Italy and UK. All of the studies were reviewed by a panel of paediatric neuroradiologists experienced in iuMR with the aid of an algorithm designed to categorise the abnormalities.

Results: Consensus expert review confirmed 356 foetuses with CFA and the first level of classification distinguished bilateral CFA (229/356-64%) from unilateral CFA (127/356-36%) cases with sub-classification of the bilateral cases into asymmetric (65/356-18%) and symmetric (164/356-46%) involvement. There was a statistically significant excess of foetuses with small head size, e.g. 17% of the cohort had a bi-parietal diameter < 3rd centile. There was a small but statistically significant excess of males in the cohort. Further categorisation was made on fine anatomical structure.

Conclusions: It is often not possible to classify foetal CFA using the principles and nomenclature used in paediatric neuroradiology. We have created a classification system for foetal CFA based on the analysis of 356 cases and believe that this will assist future research designed to correlate ante-natal and post-natal imaging features and understand the clinical sequelae of CFA described in utero.

Key Points: • We describe a morphological classification system of foetal brain cortical formation abnormalities that can be used in clinical practice. • This classification system can be used in future research studies to evaluate the long-term imaging and clinical outcomes of foetal brain cortical formation abnormalities in 17- to 38-week gestational age range. • The practical value of the work is in providing a framework and language to look for imaging clues that may differentiate between different CFA in further studies.
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http://dx.doi.org/10.1007/s00330-020-06899-2DOI Listing
October 2020

Optic Nerve Sheath Diameter is not Related to Intracranial Pressure in Subarachnoid Hemorrhage Patients.

Neurocrit Care 2020 10;33(2):491-498

Neuroscience Intensive Care Unit, Department of Anesthesia and Critical Care, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.

Background: Intracranial pressure (ICP) monitoring is essential after subarachnoid hemorrhage (SAH) to prevent secondary brain insults and to tailor individualized treatments. Optic nerve sheath diameter (ONSD), measured using ultrasound (US), could serve as a noninvasive bedside tool to estimate ICP, avoiding the risks of hemorrhage or infection related to intracranial catheters. The aims of this study were twofold: first, to explore the reliability of US for measuring ONSD; second, to establish whether the US-ONSD can be considered a proxy for ICP in SAH patients early after bleeding. For the first aim, we compared the ONSD measurements given by magnetic resonance imaging (MRI-ONSD) with the US-ONSD findings. For the second aim, we analyzed the relationship between US-ONSD measurements and ICP values.

Methods: Adult patients with diagnosis of aneurysmal SAH and external ventricular drainage system (EVD) were included. Ten patients were examined by MRI to assess ONSD, and the results were compared to the diameter given by US. In 20 patients, the US-ONSD values were related to ICP measured simultaneously through EVD. In ten of these patients, we explored the changes in the US-ONSD at the time of controlled and fairly rapid changes in ICP after cerebrospinal fluid (CSF) drainage.

Results: US-ONSD measurements at the bedside were accurate, very similar to the diameters measured by MRI (the mean difference in the Bland-Altman plot was 0.08 mm, 95% limits of agreement: - 1.13; + 1.23 mm). No clear relationship was detectable between the ICP and US-ONSD, and a linear regression model showed an angular coefficient very close to 0 (p > 0.05). US-ONSD and ICP values were in agreement after CSF drainage and shifts in ICP in a limited number of patients.

Conclusions: US-ONSD measurement does not accurately estimate ICP in SAH patients in the intensive care unit.
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http://dx.doi.org/10.1007/s12028-020-00970-yDOI Listing
October 2020

Virtual simulation with Sim&Size software for Pipeline Flex Embolization: evaluation of the technical and clinical impact.

J Neurointerv Surg 2020 Oct 28;12(10):968-973. Epub 2020 Feb 28.

Neuroradiology, CHU Montpellier, Montpellier, France.

Introduction: During flow diversion, the choice of the length, diameter, and location of the deployed stent are critical for the success of the procedure. Sim&Size software, based on the three-dimensional rotational angiography (3D-RA) acquisition, simulates the release of the stent, suggesting optimal sizing, and displaying the degree of the wall apposition.

Objective: To demonstrate technical and clinical impacts of the Sim&Size simulation during treatment with the Pipeline Flex Embolization Device.

Methods: Consecutive patients who underwent aneurysm embolization with Pipeline at our department were retrospectively enrolled (January 2015-December 2017) and divided into two groups: treated with and without simulation. Through univariate and multivariate models, we evaluated: (1) rate of corrective intervention for non-optimal stent placement, (2) duration of intervention, (3) radiation dose, and (4) stent length.

Results: 189 patients, 95 (50.2%) without and 94 (49.7%) with software assistance were analyzed. Age, sex, comorbidities, aneurysm characteristics, and operator's experience were comparable among the two groups. Procedures performed with the software had a lower rate of corrective intervention (9% vs 20%, p=0.036), a shorter intervention duration (46 min vs 52 min, p=0.002), a lower median radiation dose (1150 mGy vs 1558 mGy, p<0.001), and a shorter stent length (14 mm vs 16 mm, p<0.001).

Conclusions: In our experience, the use of the virtual simulation during Pipeline treatment significantly reduced the need for corrective intervention, the procedural time, the radiation dose, and the length of the stent.
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http://dx.doi.org/10.1136/neurintsurg-2020-015813DOI Listing
October 2020

Cochlear implantation in Ménière's disease: a systematic review of literature and pooled analysis.

Int J Audiol 2020 06 6;59(6):406-415. Epub 2020 Feb 6.

Audiology Unit, Dept of Clinical Sciences and Community Health, University of Milan, Milan, Italy.

The aim of this study was to evaluate the effect of cochlear implantation (CI) in advanced Ménière's disease (MD). The initial search on PubMed, EMBASE, and Cochrane databases yielded 171 articles; no language restriction was applied. A total of 11 articles met the inclusion criteria and were included in this systematic review. Six articles provided patient-level data on improvement in speech recognition testing after CI. The methodological quality of included studies was assessed by examining the study design, level of evidence, method of measurement and adequacy of outcome reporting. A random-effect model was fitted for calculating weighted means. Post-operative improvement in word recognition score (WCS) was 50.8% (95% confidence interval: 34.6-67.1%); general improvement of vestibular symptoms after CI was found in 67% of the pooled patients; when reported in the studies, quality of life (QoL) and tinnitus were also generally improved after CI. CI in advanced MD is a valid option providing good outcomes in terms of speech performances, regardless of the disease duration, uni- or bilaterality, age at implantation, previous therapeutic procedures and stage of activity of MD.
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http://dx.doi.org/10.1080/14992027.2020.1720922DOI Listing
June 2020

Toward a marker of upper motor neuron impairment in amyotrophic lateral sclerosis: A fully automatic investigation of the magnetic susceptibility in the precentral cortex.

Eur J Radiol 2020 Mar 11;124:108815. Epub 2020 Jan 11.

Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Neuroradiology Unit, Via Francesco Sforza 35, Milan, Italy; Department of Pathophysiology and Transplantation, Università Degli Studi Di Milano, Italy.

Purpose: Diagnostic work-up in motor neuron disease (MND) needs a quantitative biomarker of upper motor neuron (UMN) impairment. We investigated the susceptibility properties of the precentral cortex in a cohort of patients affected by Amyotrophic lateral sclerosis (ALS) to obtain a useful biomarker of UMN impairment in a fully automatic paradigm.

Materials And Methods: We retrospectively collected imaging and clinical data of 42 ALS patients who had undergone brain 3 T MRI including tridimensional T1-weighted and spoiled gradient-echo multi-echo T2-weighted images. We further acquired images from 23 healthy control (HC) volunteers. The precentral cortex was automatically segmented and the cortical thickness calculated. Histogram metrics (mean, median, standard deviation, skewness, kurtosis) derived from the quantitative susceptibility map (QSM) were extracted from the automatically segmented precentral cortex. Multivariate regression analyses were performed to identify the variables predicting the disease status (ALS vs HC), the Amyotrophic Lateral Sclerosis Functional Rating Scale-Revised (ALSFRS-R) and the UMN score.

Results: A decreased cortical thickness (B = 9.40; Wald's test = 7.43; p = 0.006) and increased susceptibility skewness (B = -3.08; Wald's test = 4.36; p = 0.037) independently predicted ALS in a logistic regression model (χ(3, N = 65) = 22.07, p < 0.001. No predictors of ALSFRS-R were identified. An increased susceptibility skewness (β = 0.55; t = 4.23; p < 0.001) and longer disease duration (β = 0.35; t = 2.67; p = 0.011) independently predicted a higher UMN score in a linear regression model (R = 0.32; p < 0.001).

Conclusion: The susceptibility skewness might be an unbiased quantitative biomarker of UMN impairment in ALS patients.
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http://dx.doi.org/10.1016/j.ejrad.2020.108815DOI Listing
March 2020

Prenatal magnetic resonance imaging within the 26th week of gestation may predict the fate of isolated upward rotation of the cerebellar vermis: insights from a multicentre study.

Eur Radiol 2020 Apr 3;30(4):2161-2170. Epub 2020 Jan 3.

Department of Pediatric Radiology and Neuroradiology, V. Buzzi Children's Hospital, Milan, Italy.

Objectives: We investigated whether prenatal magnetic resonance imaging (MRI) within 26 weeks of gestation (GW) may predict the fate of isolated upward rotation of the cerebellar vermis (URCV).

Methods: This retrospective multicentre observational study included foetuses diagnosed with isolated URCV in prenatal MRI performed within 26 GW. Isolated URCV was defined by a brainstem-vermis angle (BVA) ≥ 12° in the MR midline sagittal view without abnormalities of the supratentorial structures, brainstem, or cerebellum hemispheres. The assessments included the BVA, clival-supraoccipital angle, transverse diameter of the posterior cranial fossa, tentorial angle, width of the cisterna magna (WCM), ventricular width, vermian diameters, hypointense stripes, and cerebellar tail sign. Late prenatal or postnatal MRI was used as a reference standard to assess the final vermian fate (rotated/de-rotated).

Results: Forty-five foetuses (mean GW at prenatal MRI = 21.5 ± 1.4 weeks) were included. In the reference standard, the vermis was de-rotated in 26 cases (57.7%). At least two of the following criteria were used to predict the persistence of URCV at imaging follow-up: BVA ≥ 23°, WCM ≥ 9 mm, and the cerebellar tail sign. The results were a sensitivity of 84.21% (95% CI, 60.4-96.6%), specificity of 80.8% (95% CI, 60.6-93.4%), positive predictive value of 76% (95% CI, 58.7-87.8%), and negative predictive value of 87.5% (95% CI, 70.9-95.2%).

Conclusions: MRI within 26 GW on foetuses diagnosed with isolated URCV may predict delayed cerebellar vermis de-rotation, which is associated with good neurodevelopmental outcome in most cases.

Key Points: • Foetal MRI is a valuable tool in predicting the fate of isolated upward-rotated cerebellar vermis. • A wider angle between the brainstem and vermis is associated with higher risk of persistence of vermian rotation. • The presence of ≥ 2 factors among a brainstem-to-vermis angle ≥ 23°, width of the cisterna magna ≥ 9 mm, and the presence of the "cerebellar tail sign" has a sensitivity of 84.21% (95% CI, 60.4-96.6%) and specificity of 80.8% (95% CI, 60.6-93.4%) in predicting the persistence of the vermian rotation at imaging follow-up.
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http://dx.doi.org/10.1007/s00330-019-06538-5DOI Listing
April 2020

Herpes Simplex virus type 2 myeloradiculitis with a pure motor presentation in a liver transplant recipient.

Transpl Infect Dis 2020 Feb 1;22(1):e13236. Epub 2020 Jan 1.

Department of Pathophysiology and Transplantation (DEPT), Dino Ferrari Centre, Neuroscience Section, University of Milan, Milan, Italy.

In this case report, we describe the first PCR-confirmed case of HSV2 myeloradiculitis with a purely motor presentation, occurring in a 68-year-old liver transplant recipient. The patient reported ascending weakness with no sensory nor sphincteric symptoms, thereby resembling acute demyelinating inflammatory neuropathy, or Guillain-Barré syndrome. HSV2 was detected in cerebrospinal fluid by PCR, and the patient was successfully treated with intravenous Acyclovir.
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http://dx.doi.org/10.1111/tid.13236DOI Listing
February 2020

Feasibility of 3D printed salivary duct models for sialendoscopic skills training: preliminary report.

Eur Arch Otorhinolaryngol 2020 Mar 16;277(3):909-915. Epub 2019 Dec 16.

Department of Otorhinolaryngology, University of Pavia, Foundation IRCCS Policlinico "San Matteo", Viale Camillo Golgi, 19, 27100, Pavia, Italy.

Purposes: To explore the feasibility of 3D printed salivary duct models for the sialendoscopic skills training.

Methods: Healthy volunteers and patients affected by obstructive salivary gland disorders were submitted to 3 Tesla MR sialography. The MR data underwent an image segmentation process to produce the 3D printed salivary duct prototypes. Sialendoscopies were carried out by three groups of investigators with different levels of endoscopic experience. Realism, usefulness of the training process and potential advantages of the 3D printed models in the preoperative surgical planning were evaluated by means of a specific survey.

Results: Four cases were included in our study: one healthy parotid, one submandibular gland, one case of lithiasis and one of stenosis involving the parotid gland. In all cases, the three groups of investigators successfully explored the salivary ducts up to the tertiary branches, detected the cause of obstruction and correctly treated it. Seven untoward events occurred during the operative sialendoscopies. Overall, the questionnaire score was about 79.3%, reflecting a positive impression regarding the models on behalf of all the investigators.

Conclusions: 3D printed salivary duct models resulted feasible for the sialendoscopic skills training. The opportunity to reproduce the patient-specific anatomy may add further information useful in the preoperative decision making. These positive results should be verified by further researches and experiences.
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http://dx.doi.org/10.1007/s00405-019-05763-4DOI Listing
March 2020

Early Magnetic Resonance Imaging for Patients With Idiopathic Sudden Sensorineural Hearing Loss in an Emergency Setting.

Otol Neurotol 2019 10;40(9):1139-1147

Otolaringology-Head and Neck surgery Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico.

Objective: The role of magnetic resonance (MR) imaging in idiopathic sudden sensorineural hearing loss (ISSHL) is controversial due to the inhomogeneity of clinical and MR protocols. The aim of this work is to relate early MR findings obtained immediately after the admission, with the clinical presentation, the audiological findings, and the outcomes of treatment.

Study Design: Prospective observational study.

Setting: Tertiary referral university center.

Patients: Forty-seven patients (22 M, 25 F; age: 54.4 ± 17.5 yr) consecutively referred to the Department of Emergency for ISSHL.

Interventions: All patients underwent the diagnostic and therapeutic work-up for ISSHL, and MR imaging within 72 hours from the admission, independently of the symptoms onset. All patients received the same treatment (systemic steroid therapy, intratympanic steroid injection, and hyperbaric oxygen therapy).

Main Outcome Measure(s): MR patterns, clinical, and laboratory findings.

Results: MR imaging was positive in 25 of 47 cases (53%), with a perfect agreement between clinical and MR examinations (Cohen K = 1) upon the affected ear. Three different radiological patterns were observed: labyrinthine haemorrhage (n = 5), acute inflammatory process (n = 14), isolated blood-labyrinth barrier breakdown (n = 6). By binary logistic regression, only vertigo was associated with a positive MR imaging [B = 2.8; p = 0.011; OR = 9.5 (95% CI: 2.2-40.8)] and the latter was the only variable associated with an unfavorable outcome [(B = 2.8; p = 0.02 OR = 12.8 (95% CI: 2.9-56.7)].

Conclusion: Patients affected by ISSHL with associated vertigo show a higher likelihood of having a positive MR imaging, which, in turn, seems to predict an unfavorable outcome.
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http://dx.doi.org/10.1097/MAO.0000000000002389DOI Listing
October 2019

Audiovestibular Phenotypes and Advanced Magnetic Resonance Imaging Features of Cochlin Gene Mutation Carriers.

Audiol Neurootol 2019 7;24(4):166-173. Epub 2019 Aug 7.

Audiology Unit, Department of Clinical Sciences and Community, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy.

Objective: To describe clinical and imaging findings in a group of patients affected by nonsyndromic deafness A9 (DFNA9), using advanced magnetic resonance imaging (MRI) with 3-dimensional (3D) fluid-attenuated inversion recovery (FLAIR) sequence.

Method: A retrospective case review was conducted in a tertiary referral center in Italy. Four sequential adult DFNA9-affected patients, who had undergone MRI at our Department between January 2017 and June 2018, were enrolled (male = 2, female = 2; median age: 65.6 years; 8 diseased ears analyzed). Three patients were relatives; the fourth was unrelated. The main outcome measures - age, sex, records of audiological and vestibular testing, genetic assessment, MRI findings - were analyzed.

Results: All subjects suffered from bilateral progressive sensorineural hearing loss, more severely at the high frequencies and with a typical clinical pattern of bilateral chronic degenerative cochleovestibular deficit. Aural fullness was reported at the onset of the disease. All patients revealed a pathogenic heterozygous mutation in the Limulus factor C, Coch-5b2 and Lgl1 domain of cochlin. None of the patients showed a significant vestibular and cochlear endolymphatic hydrops at MRI, while high bilateral contrast enhancement on 4-h delayed postcontrast 3D FLAIR sequence was observed in all ears.

Conclusions: Increased perilymph enhancement on 4-h delayed postcontrast 3D FLAIR sequence is the common imaging feature of DFNA9 ears, suggesting that blood-labyrinthine barrier breakdown may play the main role in the pathophysiology of this disease. Significant hydrops has been excluded by MRI. This finding might be clinically useful in differentiating DFNA9 disease from other pathologies with similar clinical findings like Ménière's disease.
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http://dx.doi.org/10.1159/000501292DOI Listing
May 2020

Intrauterine fetal MR versus postmortem MR imaging after therapeutic termination of pregnancy: evaluation of the concordance in the detection of brain abnormalities at early gestational stage.

Eur Radiol 2019 Jun 12;29(6):2740-2750. Epub 2018 Dec 12.

Pediatric Radiology and Neuroradiology Department, Children's Hospital V. Buzzi - ASST Fatebenefratelli-Sacco, Via Castelvetro 32, 20154, Milan, Italy.

Background And Purpose: Fetal postmortem MR Imaging (pmMRI) has been recently used as an adjuvant tool to conventional brain autopsy after termination of pregnancy (TOP). Our purpose was to compare the diagnostic performance of intrauterine MRI (iuMRI) and pmMRI in the detection of brain anomalies in fetuses at early gestational age (GA).

Material And Methods: We retrospectively collected 53 fetuses who had undergone iuMRI and pmMRI for suspected brain anomalies. Two pediatric neuroradiologists reviewed iuMRI and pmMRI examinations separately and then together. We used Cohen's K to assess the agreement between pmMRI and iuMRI. Using the combined evaluation iuMRI+pMRI as the reference standard, we calculated the "correctness ratio." We used Somers' D to assess the cograduation between postmortem image quality and time elapsed after fetus expulsion.

Results: Our data showed high agreement between iuMRI and pmMRI considering all the categories together, for both observers (K1 0.84; K2 0.86). The correctness ratio of iuMRI and pmMRI was 79% and 45% respectively. The major disagreements between iuMRI and pmMRI were related to postmortem changes as the collapse of liquoral structures and distorting phenomena. We also found a significant cograduation between the time elapsed from expulsion and pmMRI contrast resolution and distortive phenomena (both p < 0.001).

Conclusions: Our study demonstrates an overall high concordance between iuMRI and pmMRI in detecting fetal brain abnormalities at early GA. Nevertheless, for the correct interpretation of pmMRI, the revision of fetal examination seems to be crucial, in particular when time elapsed from expulsion is longer than 24 h.

Key Points: • IuMRI and pmMRI showed overall high concordance in detecting fetal brain abnormalities at early GA. • PmMRI corroborated the antemortem diagnosis and it could be a valid alternative to conventional brain autopsy, only when the latter cannot be performed. • Some caution should be taken in interpreting pmMR images when performed after 24 h from fetal death.
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http://dx.doi.org/10.1007/s00330-018-5878-0DOI Listing
June 2019

Three-Tesla magnetic resonance imaging of the vestibular endolymphatic space: A systematic qualitative description in healthy ears.

Eur J Radiol 2018 Dec 24;109:77-82. Epub 2018 Oct 24.

Neuroradiology Unit, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Milan, Italy; Postgraduate School of Radiodiagnostics, Università degli Studi di Milano, Milan, Italy; Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy.

Background And Purpose: A detailed knowledge of the normal Magnetic Resonance (MR) anatomy of the vestibular endolymphatic space (ES) could be useful to understand the linkage between endolymphatic hydrops (EH) and Ménière's disease (MD). Our aim was to describe the MR anatomy of the vestibular ES as depicted by MR imaging in healthy ears.

Methods: This report describes a single-center retrospective study. Three readers analyzed the healthy ears of 22 consecutive patients who had undergone MRI for unilateral sudden hearing loss. The readers described the vestibular ES based on a delayed post-contrast 3D-FLAIR sequence according to six well-defined planes, three oblique sagittal (lateral, intermediate and medial) planes and three axial (superior, intermediate and inferior) planes.

Results: On sagittal lateral and intermediate planes, we identified the SSC ampulla combined with the utricle in 22/22 ears. On the sagittal medial plane, the saccule was detectable in 15/22 (68%) ears, having a club shape with the long axis oriented cranio-caudally; in 7/22 (32%) ears, the saccule presented an oval/round shape that appeared more conspicuously on the axial intermediate plane. The ES occupied the half superior portion of the vestibule in 22/22 ears, never contacting the round and oval windows. On the axial plane, in 17/22 cases, the ES showed a Y-shaped arrangement, while in 5/22 ears (23%), the ES presented a more globular shape.

Conclusion: MR imaging represents a valid tool to explore the in vivo anatomy of the vestibular ES and to highlight its variability in normal ears.
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http://dx.doi.org/10.1016/j.ejrad.2018.10.023DOI Listing
December 2018

Flat-panel CT versus 128-slice CT in temporal bone imaging: Assessment of image quality and radiation dose.

Eur J Radiol 2018 Sep 24;106:106-113. Epub 2018 Jul 24.

Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Neuroradiology Unit, Milan, Italy. Electronic address:

Objective: We compared the image quality and radiation dose of flat-panel CT (FPCT) and multi-slice CT (MSCT) performed respectively with an angiographic unit and a 128-slice CT scanner. We investigated whether the higher spatial resolution of FPCT translated into higher image quality and we sought to eliminate inter-subject variability by scanning temporal bone specimens with both techniques.

Materials And Methods: Fifteen temporal bone specimens were imaged with FPCT and MSCT. Two neuroradiologists experienced in otoradiology evaluated 30 anatomical structures with a 0-2 score; 18 structures important from a clinical perspective were assigned a twofold value in calculation of the overall score. The radiation dose was calculated through the use of an anthropomorphic phantom.

Results: The image quality was significantly higher for FPCT than MSCT for 10 of the 30 anatomical structures; the overall score was also significantly higher for FPCT (p = 0.001). The equivalent dose of the two techniques was very similar, but with different effective doses to the organs.

Conclusion: FPCT performed on an angiographic unit provides higher image quality in temporal bone assessment compared to MSCT performed on a 128-slice CT scanner thanks to its higher spatial resolution, with comparable equivalent doses but different effective doses to the organs.
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http://dx.doi.org/10.1016/j.ejrad.2018.07.013DOI Listing
September 2018

Brain-injured Survivors of Monochorionic Twin Pregnancies Complicated by Single Intrauterine Death: MR Findings in a Multicenter Study.

Radiology 2018 08 24;288(2):582-590. Epub 2018 Apr 24.

From the Neuroradiology Unit, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20142, Milan, Italy (G.C., F.T.); Division of Paediatric Radiology and Neuroradiology, Ospedale dei Bambini V. Buzzi, Milan, Italy (G.C., A.R., C.P., C.D.); Academic Unit of Radiology, University of Sheffield, Sheffield, England (P.D.G.); Fetal Therapy Unit Umberto Nicolini, Department of Woman Mother and Neonate, Ospedale dei Bambini V. Buzzi, Milan, Italy (M.R., M.L.); Centre of Women's and Newborn's Health, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, England (F.L.M.); Neuroradiology Unit, Spedali Civili, Brescia, Italy (L.P., C.A.); Department of Obstetrics and Gynecology, Università degli Studi di Brescia, Brescia, Italy (F.P., A.F.); Division of Prenatal Diagnosis, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Milan, Italy (N.P.); Department of Radiology, Sheffield Teaching Hospitals Foundation Trust, Sheffield, England (M.S.I., N.S.); Department of Fetal Medicine, University of Birmingham, Birmingham, England (M.K.); Pediatric Neuroradiology Unit, Istituto Giannina Gaslini, Genoa, Italy (M.S., A.R.); and Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy (F.T.).

Purpose To describe and classify the range of brain injuries present at prenatal, in-utero magnetic resonance (MR) imaging in co-twin survivors of monochorionic (MC) twin pregnancies complicated by single intrauterine death (SIUD). Materials and Methods This retrospective, observational study from six tertiary fetal medicine centers that perform tertiary-level prenatal in-utero MR studies reviewed cases in which prenatal in-utero MR imaging had shown a brain injury in a surviving co-twin of a twin pregnancy with a MC component complicated by SIUD. Results Forty-two surviving MC twins were described. The primary distinction of brain abnormalities was into nonfocal and focal lesions. The nonfocal lesions included periventricular leukomalacia (group 1; two fetuses), generalized encephalomalacia (group 2; nine fetuses), posterior encephalomalacia (group 3; seven fetuses), and bilateral parasagittal and perisylvian injury (group 4; three fetuses). The focal lesions included nonhemorrhagic lesions (group 5; 14 fetuses) and hemorrhagic lesions (group 6; seven fetuses). Focal brain lesions were more likely to be found in the surviving MC pregnancies complicated by twin-twin transfusion syndrome (TTTS) (odds ratio, 2.4; 95% confidence interval: 1.3, 18.5; P = .01) and in fetuses that underwent an obstetric intervention (odds ratio, 2.8; 95% confidence interval: 1.8, 23.6; P = .006). Conclusion Brain injury of the surviving co-twin after SIUD in MC pregnancies is usually of ischemic origin and spares the brainstem and cerebellum. Focal brain lesions are more frequent in pregnancies complicated by TTTS or in those where an intervention has been performed.
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http://dx.doi.org/10.1148/radiol.2018171267DOI Listing
August 2018
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