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Biomedical subjects

U Salvolini

Publications and source records attributed to U Salvolini.

At least 37 records · Page 2Linked to original sources

Localization of the first and second somatosensory areas in the human cerebral cortex with functional MR imaging.

BACKGROUND AND PURPOSE: Our objective was to map by means of a conventional mid-field (1.0 T) MR imaging system the somatosensory areas activated by unilateral tactile stimulation of the hand, with particular attention to the areas of the ipsilateral hemisphere. METHODS: Single-shot echo-planar T2*-weighted imaging sequences were performed in 12 healthy volunteers to acquire 10 contiguous 7-mm-thick sections parallel to the coronal and axial planes during tactile stimulation of the hand. The stimulation paradigm consisted of brushing the subjects' palm and fingers with a rough sponge at a frequency of about 1 Hz. RESULTS: Stimulation provoked a signal increase (about 2% to 5%) that temporally corresponded to the stimulus in several cortical regions of both hemispheres. Contralaterally, activation foci were in the anterior parietal cortex in an area presumably corresponding to the hand representation zone of the first somatosensory cortex, in the posterior parietal cortex, and in the parietal opercular cortex forming the upper bank of the sylvian sulcus and probably corresponding to the second somatosensory cortex. Activation foci were also observed in the frontal cortex. Ipsilaterally, activated areas were in regions of the posterior parietal and opercular cortices roughly symmetrical to those activated in the contralateral hemisphere. The same activation pattern was observed in all subjects. CONCLUSION: The activated areas of the somatosensory cortex described in the present study corresponded to those reported in other studies with magnetoelectroencephalography, positron emission tomography, and higher-field functional MR imaging. An additional area of activation in the ipsilateral parietal operculum, unnoticed in other functional MR imaging studies, was also observed.

Adult↗

Contrast-enhanced MR angiography (CE MRA) in the study of the carotid stenosis: comparison with digital subtraction angiography (DSA).

PURPOSE: To determine sensitivity, specificity and diagnostic accuracy of contrast-enhanced magnetic resonance angiography (CE MRA) compared to digital subtraction angiography (DSA) in the study of carotid stenosis. METHODS AND MATERIAL: We studied 23 patients with suspected cerebro-vascular insufficiency by carotid stenosis. Diagnostic examinations by means of CE MRA and DSA were carried out within 24 hours of each other. A 1.5 T superconductive magnet (Signa-General Electric) was used for CE MRA. This technique was performed using a fast spoiled gradient echo recalled (SPGR) sequence acquired in coronal plane 13 sec after injection of contrast medium. Imaging parameters were: TR/TE/FA 8 msec/1 msec/60 degrees, matrix 256 x 128, 1 excitation, FOV 18 x 13 cm, 28 slices per slab, slice thickness of 1 mm, acquisition time of 32 sec. The post-processing was performed using maximum intensity projection (MIP) and targeted MIP. For DSA examinations a Politron 1000 VR unit (Siemens) was used. RESULTS: In the identification and quantification of lesions, CE MRA showed values of 100%. In particular, in comparison to DSA, CE MRA was accurate in diagnosing all true negative and positive cases. The location of stenosis evaluated with CE MRA agreed in all cases with DSA. CONCLUSION: In our experience CE MRA proved to be a very valuable technique in diagnosing carotid stenosis, showing the same diagnostic accuracy as DSA. In this way CE MRA appears to be a substantial alternative technique to conventional MRA and other non-invasive diagnostic methods.

Aged↗

Carotid stenosis: a comparison between MR and spiral CT angiography.

We performed a preliminary study comparing three-dimensional time-of-flight (3 D TOF) magnetic resonance angiography (MRA) and spiral CT angiography (SCTA) in the detection and assessment of internal carotid artery stenosis. Digital subtraction angiography (DSA) was the reference examination. We examined 20 patients with signs of cerebrovascular insufficiency, who underwent MRA, SCTA and DSA within a 3 day period. Both internal carotid arteries were assessed by three blinded readers for degree of stenosis at two different levels (bulb and remaining section) giving a total of 80 assessments. Interobserver variability, sensitivity, specificity, diagnostic accuracy, concordance, overestimation and underestimation were assessed. Interobserver variability was not statistically significant. MRA showed higher sensitivity, specificity, diagnostic accuracy and concordance than SCTA (92.0% vs 80.8%, 98.2% vs 96.4%, 96.3% vs 91.3% and 96.0% vs 88.0%, respectively). MRA gave rise to a 5.0% overestimation rate, whereas SCTA occasioned a 7.5% underestimation rate. These differences are not statistically significant. These results suggest that MRA is a more useful, noninvasive modality for assessment of the internal carotid artery with a more than 70% stenosis.

Aged↗

High-resolution magnetic resonance angiography of the internal carotid artery: 2D vs 3D TOF in stenotic disease.

The aim of this study was to compare high-resolution 2D TOF with high-resolution 3D TOF in the study of internal carotid artery disease. Sixty-four patients with clinical signs of cerebrovascular insufficiency were studied with a superconductive 1.5 T magnet using two techniques: 2D and 3D TOF. Digital subtraction angiography (DSA) was the gold standard. The 2D TOF technique was performed using the following parameters: TR/TE/FA/MA 49 ms/9 ms/60 degrees/512 x 256; the 3D TOF was performed with the following parameters: TR/TE/FA/MA 50 ms/8 ms/20 degrees/512 x 256. The 2D TOF agreed with DSA in 116 of 128 diagnostic judgments (90%) and overestimated seven times. The 3D TOF technique agreed with DSA in 125 of 128 diagnostic judgments (97%) with one overestimation and two underestimations. There was no statistically significant difference (P < 0.05) between the two different techniques. Our study confirms the high reliability of the methodology carried out with the high-resolution 2D and 3D technique.

Angiography, Digital Subtraction↗

Minor cerebral alterations observed by magnetic resonance imaging in syndromic children with mental retardation.

OBJECTIVE: To evaluate the anomalies of the central nervous system (CNS) by magnetic resonance imaging (MRI) in normal subjects and in syndromic patients. METHODS AND MATERIAL: Seventy-three normal subjects and 50 different syndromic patients with mental retardation (from 3 months to 16 years) were studied utilizing several morphometric parameters (degree of myelination of the white matter, evaluation of liquoral spaces, septo-caudate distance, Evans index, Aboulezz method, and length, width and angles of corpus callosum). RESULTS: A high frequency of anomalies of the corpus callosum, the Chiari anomaly and alterations either of the white matter or of the ventricular and periencephalic system have been observed. CONCLUSION: The authors point out the importance of cerebral MRI in the study of CNS in patients with malformation syndromes. The present research, carried out on a large number of both normal subjects and patients with malformation syndromes, represents one of the first systematic studies in this field.

Adolescent↗

MR angiography in carotid stenosis: a comparison of three techniques.

PURPOSE: To compare the accuracy of three different magnetic resonance angiography (MRA) techniques for studying steno-occlusive disease of carotid arteries. METHODS: 64 patients were evaluated with three MRA techniques- three-dimensional (3D) time-of-flight (TOF), two-dimensional (2D) TOF, and 3D Phase-Contrast (PC); the acquisition was in the axial plane, the volume included the carotid bifurcation. Digital subtraction angiography (DSA) was considered the 'gold standard'. The MRA images were reprojected with a maximum intensity pixel ray-tracing (MIP) algorithm. The three MRA techniques were blindly graded as normal, mildly stenotic (0-29%), moderately stenotic (30-49%), severely stenotic (70-99%), or occluded. RESULTS: DSA provided 128 diagnostic judgments: 92 were negatives and 36 positives. 2D TOF was in agreement with angiography in 116 of 128 cases (90%), but overestimated the results in seven cases and underestimated in five cases. 3D TOF agreed with angiography in 125 of 128 cases (97%), with one overestimation and two under estimations. 3D PC was concordant in 116 of 128 cases (90%), overestimating in six cases, underestimating in six cases. The sensitivity, specificity and diagnostic accuracy for 2D TOF was, respectively 84%, 94%, and 92%, while for 3D TOF was 94%, 100%, and 98%, and for 3D PC 86%, 98%, and 95%. The comparison of the three different MRA techniques provided no statistically significant difference (Friedman test P < 0.05). CONCLUSION: The high degree of diagnostic accuracy of MRA found in the study of the steno-occlusive disease of the carotid arteries confirms the high degree of reliability of this methodology carried out with the 3D TOF technique, compared to 2D TOF and 3D PC.

Carotid Arteries↗

Hippocampus and parahippocampal gyrus linear measurements based on magnetic resonance in Alzheimer's disease.

MRI-based linear measurements of the hippocampus and parahippocampal gyrus complex (HPC) discriminated 39 subjects with probable Alzheimer's disease, from 15 patients with other dementias and 33 miscellaneous controls without evidence of dementia. The best discriminating parameter was the left height of the HPC at the level of the mammillary bodies, with a sensitivity of 79.49% and a specificity of 68.75%. The diagnostic value of these results is discussed considering the volumetric data found in the current literature.

Adult↗

[Stenosis-occlusion of the carotid bifurcation. Angiography with MR and contrast media versus digital angiography].

PURPOSE: To evaluate the comparative sensitivity, specificity and diagnostic accuracy of contrast enhanced magnetic resonance angiography (CE MRA) and digital subtraction angiography (DSA) in the study of carotid bifurcation stenoses. MATERIAL AND METHODS: Twenty-three patients with suspected cerebrovascular insufficiency by carotid stenosis were examined with CE MRA and DSA within 24 hours of each other. A 1.5 superconductive unit (Signa, General Electric) was used for CE MRA; fast spoiled gradient echo recalled (SPGR) images were acquired on the coronal plane 12 s after contrast medium injection, with the following parameters: TR/TE/FA 8/1/60, MA 256 x 128, NEX 1, FOV 18 x 13, slices/slab 28, slice thickness 1 mm, TA 32 s. The images were postprocessed with the maximum intensity projection (MIP) and the targeted MIP algorithms. A Siemens Politron 1000 VR unit was used for DSA examinations. RESULTS: DSA diagnosed 21 true positives, namely 4 grade II, 4 grade III, 10 grade IV and 3 grade V stenoses. CE MRA scored 100% in stenosis identification and grading, accurately diagnosing all the true negatives and the true positives and was always in agreement with DSA as to stenosis site. CONCLUSION: CE MRA can be considered the technique of choice to study stenosis occlusion in the epiaortic vessels, because it permits a rapid panoramic study of the neck vessels and accurate stenosis grading with similar patterns to those of DSA. Thus, CE MRA appears to be a valid alternative to DSA.

Aged↗

Transcranial Doppler sonographic monitoring during cerebral aneurysm embolization: a preliminary report.

BACKGROUND AND PURPOSE: The wide application of embolization in the treatment of aneurysms has created the need for an intraprocedural means to anticipate a poor outcome by monitoring hemodynamic changes in the brain. METHODS: Transcranial Doppler sonography was used to monitor flow velocity in the middle cerebral artery (MCA) in 23 patients undergoing embolization with Guglielmi detachable coils (GDCs) of either incidental or symptomatic intracranial aneurysms. Sonographic values were recorded from the ipsilateral MCA at the beginning, middle, and end of the interventional procedure and 24 hours afterward. RESULTS: No complications occurred in 15 patients. In these cases, sonography showed an average decrease in MCA flow velocity of 2.7% after GDC application, returning to baseline at the end of treatment and then increasing by about 17% 24 hours later. In four patients with vasospasm on posttreatment angiograms, MCA flow velocity increased to values higher than 120 cm/s after GDC application, returning to baseline after 24 hours. In four patients with ischemic complications (two transient ischemic attacks, one stroke, one vascular death), MCA flow velocity decreased more than 30% and did not return to preoperative values within 24 hours. CONCLUSION: The application of transcranial Doppler sonographic monitoring during endovascular treatment may help to identify patients at risk for posttreatment cerebral ischemia.

Adult↗

[Magnetic resonance angiography in stenosing-occlusive diseases of the carotid arteries: 3D with time of flight versus 3D with phase contrast].

We assessed the comparative sensitivity, specificity and diagnostic accuracy of 3D time of flight (TOF) versus 3D phase contrast (PC) MRA in the study of stenoses/occlusions of the extracranial carotid artery. Fifty-four patients were submitted to MRA because of their symptoms or of signs of cerebrovascular insufficiency. 3D TOF and 3D PC axial slices were acquired with a high field magnet; digital angiography was the gold standard. The parameters of 3D TOF acquisitions were: TR/TE/FA 50/8/20, 1 NEX, 512 x 256 matrix, 16 x 12 FOV, 1 axial slab of 60 slices, 1 mm slice thickness, superior presaturation band, ramp pulse, TA 10-18 minutes. 3D PC parameters were: TR/TE/ FA 25/9/20, 1 NEX, 256 x 128 matrix, 18 x 13 FOV, 1 axial slab of 60 slices, 1 mm slice thickness, VENC 35 cm/s, TA 10-15 minutes. 3D TOF MRA was in agreement with digital angiography in 95.6% of cases (22/23), overestimating a grade 3 stenosis as grade 4 (one case, 4.3%) and underestimating no stenoses. 3D PC MRA was in agreement with digital angiography in 78.2% of cases (18/23), overestimating three stenoses (13%); one grade 1 as grade 2 and two grade 4 as grade 5; two stenoses were underestimated (8.6%); one grade 4 as grade 3 and one grade 4 as grade 2. Sensitivity, specificity and diagnostic accuracy were 91.4%, 98.9% and 95.7% for 3D TOF, versus 83.2%, 97.2% and 92.3% for 3D PC, respectively. The two MRA techniques had different semiology. In spite of outstanding background noise suppression, 3D PC poorly depicted the turbulent flow at the carotid bifurcation in carotid stenoses. Therefore, 3D TOF appears a better technique to study stenoses/occlusions of the extracranial carotid arteries.

Carotid Stenosis↗

Spiral CT angiography in the study of the carotid stenoses.

PURPOSE: To determine sensitivity, specificity and diagnostic accuracy of spiral CT angiography (S-CTA) compared to Digital Subtraction Angiography (DSA). MATERIALS AND METHODS: We studied 40 patients with suspected cerebro-vascular insufficiency by carotid stenosis. Diagnostic examinations by means of S-CTA and DSA were carried out within 24 hours of each other. Twelve of these patients underwent thromboendoarterectomy (TEA). Prospeed SX GE was used for S-CTA. Post-processing was performed using Maximum Intensity Projection (MIP) after deleting osteo-muscular structures and CT angiograms were displayed in an oblique anterior view at an angle of 10 degrees-15 degrees along the longitudinal axis. For DSA examinations, a Siemens Politron 1000 VR unit was used. RESULTS: In this study S-CTA showed values of sensitivity, specificity and diagnostic accuracy of 88%, 100% and 96%, respectively. CONCLUSIONS: In the future, with the improvement of non-invasive techniques (S-CTA, MRA), DSA should be replaced, as the gold-standard, in the evaluation of stenotic disease of the carotid bifurcation.

Adult↗

[Whole-body magnetic resonance angiography using a contrast medium. Technical optimization].

INTRODUCTION: We tried to optimize the technique of contrast enhanced MR Angiography (MRA) in the study of the main body arteries. MATERIALS AND METHODS: Fifty volunteers were examined with contrast enhanced MRA with a superconductive magnet at 1.5 T (Signa GE) and 3D SPGR sequences acquired with the following parameters: TR 8.2 +/- 1.3 ms, TE 1.8 +/- 7 ms, FA 60 degrees, MA 128 X 256; the images were acquired on the sagittal or coronal planes. The contrast agent (Gd-DTPA) was injected with MedRad Spectris system, with the bolus technique and the following standard parameters: velocity 1.5 mL/s and single dose; circulation time was optimized with 2D SPGR for each vessel (pretest). The carotid and pulmonary arteries, the thoracic-abdominal aorta and the iliac arteries were studied. The reader used a multiple choice card to evaluate image quality, signal-to-noise ratio (SNR) and circulation time. RESULTS: Circulation time was 10.2 s in the carotid arteries, 8.1 s in the pulmonary arteries, 10.3 s in the thoracic aorta, 12.2 s in the abdominal aorta and 13.8 s in the iliac arteries. The signal was 181.8 vs the noise 3.1 in the carotid arteries, 256.8 vs 23.2 in the thoracic aorta, 518.4 vs 23.5 in the pulmonary arteries, 258.8 vs 24.5 in the abdominal aorta and finally 262.7 vs 25.4 in the iliac arteries. CONCLUSIONS: Our experience suggests that contrast enhanced MRA is a good technique to study body arteries.

Adult↗

[Magnetic resonance angiography of the vessels of the neck: the optimization of a dynamic technic during the rapid infusion of a paramagnetic contrast medium].

INTRODUCTION: A new noninvasive technique, dynamic Magnetic Resonance Angiography (MRA) during rapid infusion of paramagnetic contrast medium, has been recently developed for the study of neck vessels. This study was carried out to optimize technical parameters. MATERIALS AND METHODS: Twenty healthy volunteers (10 men and 10 women; age range: 25 to 50 years) were examined with a 1.5 T MR unit equipped with fast imaging software and a dedicated coil. Dynamic MRA was performed using fast spoiled gradient recalled (fast SPGR) sequences acquired on the coronal plane 13 s after contrast medium injection. Imaging parameters were: Echo Time (TE): 1 ms, Repetition Time (TR): 8 ms, flip angle: 60 degrees, matrix 256 x 128, number of excitations: 1, field of view: 18 x 13 cm, number of partitions per slab: 28, slice thickness: 1 mm, acquisition time: 32 s. A dose of .2 mmol/kg of paramagnetic contrast medium was administered with an MR compatible automatic injector, at a speed rate of 1.5 ml/s. Angiographic images were postprocessed with the maximum intensity projection (MIP) and targeted MIP algorithms. RESULTS: Using the above parameters and rapid contrast medium injection, the carotid arteries on the coronal plane (including the vessels from the proximal aspect of the common carotid arteries to the intracranial tract of the internal carotid arteries) in 18 cases. In the other two cases the tortuosity and the position of the carotid arteries on two different planes, prevented their complete visualization. The vertebral arteries were completely demonstrated in 50% of the investigated population. Partial or total overlapping of jugular veins did not affect the recognition of the carotid vessels in 10 cases, also with targeted MIP postprocessing. DISCUSSION: The vascular semiology of dynamic gadolinium enhanced MRA seems to be closer to that of conventional angiography than of conventional MRA, likely due to the same modality of vessel depiction, based on contrast medium administration. Flow artifacts, the major pitfall of conventional MRA causing signal void and overestimation of stenosis grade, are not frequent in dynamic MRA. CONCLUSIONS: Gadolinium enhanced dynamic MRA ensures panoramic and high resolution angiographic-like depiction of the neck vessels, providing rapid and excellent definition of vascular morphology. Thus dynamic MRA appears to be a substantial alternative to conventional MRA and conventional angiography.

Adult↗