MRI in cerebrovascular ischemic disease.
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Biomedical subjects
Publications and source records attributed to G Scotti.
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More than 1300 patients have been examined with MR for diseases of the CNS since October 1983. Eight hundred patients were studied with a resistive 0.15 Tesla system and the remaining with a superconductive 0.5 Tesla system. Lesions of the cervical spinal cord, syringomyelia and intra or extra-axial tumors, were perfectly demonstrated. The absence of artefacts in the posterior fossa, as well as sagittal and coronal slices, allow an excellent demonstration of lesions, particularly of brain stem tumors. In a large group of patients with multiple sclerosis, MR has proven to be diagnostically superior to CT, evoked potentials and CSF examination. Sensitivity is very high but specificity may be low in infra- and supratentorial gliomas. Differentiation of tumor from oedema may be difficult.
Twelve patients with vascular malformations of the spinal cord have been treated by embolization at the Neuroradiological Department of the Ospedale Maggiore Niguarda Cà Granda from September 1981 to February 1984. Different materials and techniques have been used, including liophylised dura, Ivalon (PVA) and Isobutyl Cianoacrylate. All types of malformations have been encountered: dural AV fistulae, intramedullary AVMs, intradural extramedullary AV fistulae, extradural AVMs with intradural venous drainage. Nine patients improved following treatment and three remained unchanged. Embolization can be an alternative treatment to surgery and it is the treatment of choice in dural AV fistulae.
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During a 4 year period, 48 patients were treated with balloon catheters. There were 39 fistulas and nine aneurysms. Detachable balloons with a modified Debrun technique were used in 37 patients. Different kinds of technical problems were encountered. The arterial axis remained patent in 29 of the 37 fistulas; in the two mixed internal and external carotid-cavernous sinus fistulas, combined embolization with dura, isobutyl cyanoacrylate, and detachable balloon was used. In six of the nine aneurysms the arterial axis was occluded with a detachable balloon. In three of 48 patients, severe neurologic complications resulted in death.
Forty patients with symptoms and signs of radicular disease or spinal cord involvement secondary to cervical spondylosis were studied with myelography (using nonionic water-soluble contrast medium) followed by computed tomographic (CT) myelography. In 17 patients CT was also performed before myelography. CT myelography adds useful information to the myelographic findings. Cord compression is better evaluated and osteophytes can be differentiated from disk herniation. Plain CT can demonstrate a herniated disk but with less accuracy than CT myelography. Cord and root compression are not seen directly on plain CT; for this reason myelography should be the first procedure in patients with myelopathy or myeloradiculopathy, which may be followed by CT myelography.